Abstract 149: Echocardiographic Reporting and Subsequent Referral to a Pulmonary Hypertension Clinic

Abstract

Introduction: Pulmonary hypertension (PH) is a common and often ominous finding in the echocardiographic evaluation of patients with cardiopulmonary complaints. As with all diagnostic imaging, the report summary may influence future evaluation. Our aim was to explore the relationship between the echocardiographic reports of patients with PH and subsequent referral to a PH clinic. Methods: From the institutional database of a single academic medical center, we randomly selected 500 reports of patients with an estimated RVSP > 40 mm Hg between 2006 and 2014. Demographic and echocardiographic data were recorded prospectively. Referral to the only PH clinic in the region was determined by searching the electronic medical record. We used multivariable logistic regression to identify demographic and echocardiographic characteristics associated with referral. Results: The mean age of the population was 74 years and 54% (269 of 500) were women. The mean RVSP was 53 mm Hg. Pulmonary hypertension was mentioned in only 31% (153 of 500) of the report summaries and only 4.6% (23 of 500) of all patients were referred to the PH clinic. Referral was associated with younger age, indication for the echo, right atrial and right ventricular (RV) pressure, RV dilatation, and mention of PH in the summary. Mention of PH in the summary was the variable most strongly associated with referral (adjusted OR 4.6, 95% CI 1.5-14.2). Over the time period studied, there was no trend in the frequency of mentioning PH in the summary. The sonographer’s coding of PH as a preliminary finding was strongly associated with physician mention of PH in the summary, persisting after adjustment for RV systolic pressure, RV dilatation, and RV systolic function (adjusted OR 11.3, 95% CI 6.2-20.3). Conclusion: In this single institution study, PH was infrequently mentioned in the echo report summary of patients with an RVSP exceeding 40 mm Hg. Referral to the only PH clinic in the region was relatively rare but occurred more often following mention of PH in the summary. Explicitly stating the presence of pulmonary hypertension in the summary of patients with elevated RSVP may facilitate referral for comprehensive evaluation.