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Use of echocardiogram increased rapidly for nearly a decade until slowed after province-wide program change


The use of echocardiograms rapidly increased from 2002 to 2011, followed by a decrease and then a plateau after the introduction of a provincial accreditation program in 2012, according to a new study by researchers at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues.

An echocardiogram uses sound waves to produce images of the heart. This common test shows how the heart is beating and pumping blood. The images from an echocardiogram are used to identify heart disease. An echocardiogram is the most used technique for imaging heart failure patients, exceeding the use and cost of any other imaging techniques.

The study published today in JAMA Network Open examined the data of 882,355 Ontario adults with heart failure between 2002 and 2016. The researchers found there was an increase in the use of echocardiography from 386 tests per 1,000 heart failure patients in 2002 to 513 per 1,000 in 2011. In 2012, coinciding with the initiation of a program that accredited echocardiogram labs as well as introduced new standards for the use of echocardiogram organized by CorHealth, there was a drop in use (-59.5 tests per 1,000) which was followed by a plateau in subsequent years.

“It is encouraging to see that a cardiologist-led health intervention had such a large impact on curbing the use of echocardiograms. However, it is important to note that the accreditation program was launched in conjunction with other province-wide efforts such as the publication of appropriate use criteria, the ‘Choose Widely Canada’ program, and the emergence of new technologies that may have impacted physicians’ ordering patterns of cardiac imaging," says Dr. Juarez R. Braga, author on the study, cardiologist and ICES Fellow.

Heart failure is a common condition affecting two per cent of the adult population in Ontario, and that rate has remained stable in the province in the past 15 years. Echocardiograms are a low-risk and widely accepted cardiac imaging tool that help physicians diagnose and treat patients with heart failure.

"We know that people are living longer with heart failure and while the need for cardiac imaging increases, there are also concerns about excessive use of cardiac imaging without clinical justification,” says Dr. Douglas Lee, senior author on the study and ICES senior scientist.

The researchers found the annual spend for cardiac imaging in the investigation of heart failure increased by nearly two-fold from $24.8 million in 2002 to $ 49.6 million in 2016. Echocardiography was responsible for approximately 53 per cent of the total spent on cardiac imaging in 2016.

Author block: Juarez R. Braga, Howard Leong-Poi, Valeria E. Rac, Peter C. Austin, Heather J. Ross and Douglas S. Lee.

The article “Trends in the use of cardiac imaging for patients with heart failure in Canada,” is published in the August 8 issue of the JAMA Network Open.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

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