THE IMPACT OF EARLY USE OF ECHOCARDIOGRAPHY PERFORMED BY NON-CARDIOLOGIST IN PATIENTS WITH CHEST PAIN - THE ENDEMIC STUDY

Background: Echocardiography is well-established method in management of chest pain at Emergencydepartment (ED). However, evidence on the optimal scope of the examination and the education of the examiner is scarce. Primary objective was to assess the impact of POCE on length of stay on emergency department (ED). Secondary objectives were to evaluate the impact of POCE on time to revascularization and on the accuracy of the diagnosis at the initial examination.

Methods: ENDEMIC study is a prospective, randomised, open-label single centre study. Prior to enrolment, physicians without any previous experiences with POCE were educated according to BSE standard level 1. Patients were enrolled into the study and randomised in even-odd manner for POCE within 90 minutes or for usual management. In all patients the length of ED stay, time to coronary angiography and accuracy of working diagnosis. Time to revascularization was retrieved from patient´s medical records and confirmed by telephonic visit. 

Results: The study was early terminated after enrolment of 150 patients, because main objectives were met. The use of POCE resulted in a significant shortening of both time of decision (138.0 [68.5−230.5] min vs. 252.0 [165.5−304.0], p=0.000004) and length of ED stay (209.0 [143.5−260.0] min vs. 271.0 [206.5−336.0], p=0.0002. Moreover, in patients indicated for further follow-up, utilisation of POCE resulted in better concordance of working and final diagnosis: 91,6 % vs. 50 %; RR = 1.83 (1.104-2.565); p = 0.0063. Benefits of POCE were most pronounced in patients requiring hospitalization.

Conclusion: The study showed that echocardiography performed by sufficiently educated physician in patients with acute chest pain results in significant shortening of ED stay along with improved diagnostic accuracy.