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The importance of echocardiography in physicians' support of endocarditis prophylaxis.

https://arctichealth.org/en/permalink/ahliterature170280
Source
Arch Intern Med. 2006 Mar 13;166(5):549-53
Publication Type
Article
Date
Mar-13-2006
Author
Sheldon M Singh
Campbell D Joyner
David A Alter
Author Affiliation
Department of Medicine, University of Toronto, Ontario, Canada.
Source
Arch Intern Med. 2006 Mar 13;166(5):549-53
Date
Mar-13-2006
Language
English
Publication Type
Article
Keywords
Adult
Decision Making
Echocardiography
Endocarditis, Bacterial - prevention & control - ultrasonography
Guideline Adherence
Humans
Ontario
Physician's Practice Patterns
Questionnaires
Abstract
Guidelines advocate for antimicrobial prophylaxis for prevention of bacterial endocarditis. Our objective was to explore physicians' perspectives regarding the importance of echocardiography in the evaluation and management of endocarditis prophylaxis.
A total of 260 cardiologists and 300 family physicians practicing in Ontario, Canada, were surveyed. Our main outcome measures were physician ratings of the importance of a murmur, echocardiogram findings, echocardiogram comments, comorbid conditions, guidelines, patient insistence, and medicolegal concerns on the decision to recommend prophylaxis, as well as the degree of echocardiographically detected mitral valve abnormality required prior to recommending prophylaxis.
The survey response rate was 62%. Echocardiographic findings were rated by 81% of physicians as the most important factor influencing the decision to provide prophylaxis. Conversely, only 27% of physicians placed similar importance on clinical findings. Family physicians relied more heavily on echocardiographic than on clinical findings when supporting endocarditis prophylaxis recommendations. On average, prophylaxis was recommended for moderate to severe regurgitation in a normal valve and mild regurgitation in a mildly abnormal structural mitral valve. Physicians who reported greater reliance on echocardiographic findings advocated for prophylaxis at lower echocardiographic thresholds than did those who reported greater reliance on murmur detection for endocarditis prophylaxis decisions.
Physicians strongly support the use of echocardiography in endocarditis prophylaxis decision making. However, the importance of echocardiography relative to other factors varies across physician specialties. Further studies must evaluate the role of echocardiography in the assessment and management of antimicrobial endocarditis prophylaxis to assist in the development of clear clinical guidelines.
PubMed ID
16534042 View in PubMed
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