(P202) REDUCING IN-PATIENT TRANSTHORACIC ECHOCARDIOGRAM (TTE) RESOURCES AMONG LOW-RISK NON-ST ELEVATION MYOCARDIAL INFARCTION (NSTEMI) PATIENTS WITH NORMAL LEFT VENTRICULOGRAM (LVG)

Background: Guidelines recommend assessment of cardiac function following an acute coronary syndrome (ACS) since reduced left ventricular ejection fraction (LVEF) is associated with increased all-cause mortality and hospitalization from heart failure within one year of an ACS event. Studies demonstrate strong positive correlations in LVEF assessment when comparing transthoracic echocardiogram (TTE) to left ventriculogram (LVG), suggesting that performing both in an in-patient setting might be redundant. In this retrospective quality improvement study, we investigate current TTE practice among NSTEMI patients with normal LVG in Saskatoon. We predict high rates of both investigations in the in-patient setting, and consequently prolonged admissions.

METHODS AND RESULTS: A retrospective quality improvement study was conducted at the Saskatoon Royal University Hospital between August 1, 2022 and December 31, 2022. REB approval was obtained. The hospital database identified 197 NSTEMI cases. Cases were excluded if any of the following were present: abnormal LVG, cardiogenic shock, decompensated heart failure, chronic kidney disease with creatinine clearance < 40mL/min, congenital heart disease, severe valvular disease, and severe coronary artery disease requiring same-admission bypass surgery.

Eighty NSTEMI cases met inclusion criteria (80/197, 41%). Ninety-one percent of these cases underwent in-patient TTE (73/80), 60% of which were discharged within 24-hours of TTE performed (44/73). The average admission duration was 4 days, where guidelines recommend only 48 hours of monitoring post-ACS. Each additional night on the ward costs the health-care system approximately $5,000.

Conclusion: Almost all uncomplicated NSTEMI cases with normal LVG are undergoing in-patient TTE in Saskatoon despite recommendations to perform this additional imaging study in the outpatient setting. During this 6-month period, approximately 73 TTEs could have been completed as outpatient, making available ultrasound resources for other in-patient needs. Over 50% of case were awaiting a TTE prior to discharge, resulting in longer hospital stay and increased health-care expenditures.