The importance of echocardiography in physicians' support of endocarditis prophylaxis

Archives of Internal Medicine
Sheldon M SinghDavid A Alter

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 ...Continue Reading

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