THE CLINICAL IMPACT OF ECHOCARDIOGRAPHY ON ANTIBIOTIC-PROPHYLAXIS USEIN PATIENTS WITH SUSPECTED MITRAL-VALVE PROLAPSE

PURPOSE: TO determine the impact of echocardiography on the use of ant ibiotic 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 h ospital echocardiography laboratory. Chart review and phone contact we re used to determine the demographic characteristics of the patients; past diagnosis of MVP, symptoms, and exam at referral; practice specia lty of referring MD; echocardiographic findings; and change in prophyl axis usage as a result of the echocardiogram (ECHO). Prophylaxis was c onsidered to be indicated if the echocardiogram demonstrated MVP with at least mild regurgitation or abnormal thickening of at least one mit ral leaflet. RESULTS: Based on the ECHO a change in antibiotic prophyl axis 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 order ed (3%). This corresponded to 1 change in management per $36,250 in ho spital and physician costs. Younger age, female gender, and presence o f symptoms were associated with a benign ECHO. Indications for a chang e in management were not significantly different between physician spe cialties: 18% for generalists (internal medicine and family practice), 12% for cardiologists, and 7% for other specialists, P = 0.3. CONCLUS IONS: in patients referred for evaluation of MVP, echocardiography inf requently resulted in changes in antibiotic prophylaxis management and was associated with significant expense. (C) 1997 by Excerpta Medica, Inc.