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Editor's Note
September 2018

Use of Limited Transthoracic Echocardiogram: Nothing More, Nothing Less

Author Affiliations
  • 1NYC Health and Hospitals, New York, New York
JAMA Intern Med. 2018;178(9):1272. doi:10.1001/jamainternmed.2018.3483

Wouldn’t a limited transthoracic echocardiogram always provide less information than a full study? After all, a full echocardiogram will give you detailed measurements of the valves and all 4 chambers, not just limited views of the left ventricle. However, frequently, the only reason an echocardiogram is ordered is for determination of ejection fraction, such as for patients with congestive heart failure or patients undergoing cardiotoxic chemotherapy. For these patients, there is no reason to detain them or tie up the echo laboratory with a lot of irrelevant valvular measurements. And in safety net systems like the Veterans Affairs Hospital where Sandhu and colleagues1 describe the association between offering limited left ventricle echocardiograms and overall use of echocardiography, resources are finite. By reducing the time required to conduct a test, more patients can have the test for the same resources. Although less direct, even for insured populations, decreasing the cost and time it takes for a test by performing a more limited study can be beneficial. As costs of health care increase to pay for lower value tests, fewer people can afford insurance, businesses become less profitable because of the costs of providing health insurance, and employee wages stagnate because of health insurance costs.

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