A comparison of cardiologist and noncardiologist use of echocardiograms: Implications for containing health care costs

Echocardiography enables physicians to examine the heart noninvasively and provides a comprehensive evaluation of the cardiovascular system. However, because it is a relatively expensive procedure compared to an ECG or X-ray, it is crucial that "echo" be utilized appropriately and judiciously. Using a retrospective chart review, we sought to determine whether there are differences in concordance between the diagnoses and echo findings of cardiologists and those of other physicians. Due to cardiologists' greater knowledge of cardiophysiology and echocardiography, cardiologists were expected to have a higher concordance between patient diagnosis and echocardiogram findings when compared to noncardiology physicians. Randomly, 500 echo reports were assessed for diagnosis, reason for the echo, and whether the echo findings agreed with the diagnosis. Other criteria that were studied included whether there were additional, unanticipated findings and whether these findings were of major or minor importance. Concordance between cardiologist pre-test diagnosis and echo findings was found in 95 out of 175 tests (54%). Noncardiologist pre-test diagnosis concordance with echo findings was found in 117 out of 325 tests (36%) (p<0.0001). Thus, the cardiologists were found to have a significantly higher concordance between diagnosis and findings on echocardiogram when compared to noncardiologist physicians.