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Preventable errors in the performance and reporting of echocardiography and right heart catheterization can lead to diagnosis errors for pulmonary hypertension with significant implications for patients
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- Author / Creator
- Saunders, Alexandra
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Pulmonary hypertension (PH) is common and PH subgroups have vastly different mortality and treatment, particularly pulmonary arterial hypertension (PAH) versus PH secondary to heart failure with preserved ejection fraction (HFpEF). Both transthoracic echocardiography (TTE) and right heart catheterization (RHC) are needed, as diagnosis requires mean pulmonary artery pressure (mPAP) >20 mmHg either with pulmonary artery wedge pressure (PAWP) 15 mmHg for HFpEF. PAWP and mPAP can only be measured by RHC. However, TTE is what first identifies PH, triggering referral to a specialized PH center. We hypothesized that human errors in the performance and reporting of TTEs and RHC are prevalent, potentially leading to misdiagnosis of PH and its subgroups.
We re-analyzed TTEs and RHCs of 263 consecutive new patients referred to our PH program during a 5-year period. We also compared the inferred diagnosis from the referring TTE and the subsequent RHC reports to the diagnosis made after correcting for errors found. We identified numerous preventable errors in the performance and reporting of both tests. There was a poor correlation between the parameters measured by both tests (e.g., systolic PAP). The referral TTE reports missed or overcalled PH in 44 patients. The RHC, mostly by mistakes of the PAWP, led to misdiagnosis in 41 patients, (21 with true PAH labelled as HFpEF and 20 with true HFpEF labelled as PAH).
TTE errors may delay referrals and RHC errors may lead to misdiagnosis and applying wrong therapies to the wrong groups. As PAH therapies are extremely expensive, this also impacts the health care system. Primary care physicians need to be on alert for such errors and referral centers need to promote quality improvement programs that could eliminate these errors. -
- Graduation date
- Fall 2024
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- Type of Item
- Thesis
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- Degree
- Master of Science
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- License
- This thesis is made available by the University of Alberta Library with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.