The Clinical Impact of Echocardiography on Antibiotic Prophylaxis Use in Patients with Suspected Mitral Valve Prolapse

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0002-9343(97)00084-3 Byline: Paul A. Heidenreich, Jeffrey Bear, Warren Brower, Elyse Foster Abstract: PURPOSE: To determine the impact of echocardiography on the use of antibiotic prophylaxis in patients with suspected mitral valve prolapse (MVP). PATIENTS AND METHODS: We evaluated 147 consecutive patients who were referred for 'rule out mitral valve prolapse' to a university hospital echocardiography laboratory. Chart review and phone contact were used to determine the demographic characteristics of the patients; past diagnosis of MVP, symptoms, and exam at referral; practice specialty of referring MD; echocardiographic findings; and change in prophylaxis usage as a result of the echocardiogram (ECHO). Prophylaxis was considered to be indicated if the echocardiogram demonstrated MVP with at least mild regurgitation or abnormal thickening of at least one mitral leaflet. RESULTS: Based on the ECHO a change in antibiotic prophylaxis was indicated in 20 of 147 (14%) patients including initiation of prophylaxis in 6, and discontinuation of prophylaxis in 14. However, only 4 of 20 patients (20%) actually changed their prophylaxis habits leading to an actual yield of 4 management changes per 131 ECHOs ordered (3%). This corresponded to 1 change in management per $36,250 in hospital and physician costs. Younger age, female gender, and presence of symptoms were associated with a benign ECHO. Indications for a change in management were not significantly different between physician specialties: 18% for generalists (internal medicine and family practice), 12% for cardiologists, and 7% for other specialists, P = 0.3. CONCLUSIONS: In patients referred for evaluation of MVP, echocardiography infrequently resulted in changes in antibiotic prophylaxis management and was associated with significant expense. Author Affiliation: (a) Department of Health Research and Policy, Stanford University, San Francisco, CaliforniaUSA (b) Division of Cardiology, Department of Medicine University of California San Francisco, San Francisco, CaliforniaUSA (c) Department of Medicine, Department of Veterans Affairs San Francisco, CaliforniaUSA Article History: Received 2 July 1996; Accepted 13 December 1996