Background: Current guidelines for the use pre-operative non-invasive cardiac testing, especially in older patients with multi-morbidity and poor functional capacity are unclear. Our study aimed to evaluate the use of nuclear stress test (NST) and transthoracic echocardiogram (TTE) in older adults admitted to the hospital with acute hip fracture.
Methods: A 2-year, multi-center, retrospective study of all patients 65 and older, admitted to the hospital with an acute hip fracture was conducted. Data was extracted from electronic health records (EHR). The study evaluated the association between the use of pre-operative non-invasive cardiac testing (nuclear stress test or TTE) and patient-related factors (age, co-morbidities) as well as associated clinical outcomes (time to surgery [TTS], time to discharge [TTD], and in-hospital mortality). Descriptive statistics (mean and standard deviation for continuous variables, frequencies and proportions for categorical variables) were calculated. For in-hospital mortality, logistic regression modeling was utilized. For TTS and TTD, Poisson regression (specific for count data) was utilized.
Results: Of the 1,079 patients admitted with hip fracture, the average age was 84.2 years, 74.79% were female, 82.39% White, and 43.1% widowed; 0.74% had a nuclear stress test and 34.57% had a TTE prior to surgery. Patients admitted to a community hospital had almost 3 times greater odds of TTE compared with those at tertiary centers (p<0.0001). Subjects admitted to the medical service had 3.6 times greater odds of TTE compared with those on surgery (p<0.0001). The median TTS was 1.17 days (IQR: 1.1), median TTD was 5.3 days, and in-hospital mortality of 3%. While pre-operative TTE was not associated with TTD (p=0.62), in a multivariable analysis TTE was associated with increased TTS (e^0.2832=1.327 days, p<0.0001). TTE prior to surgery was not associated with in-hospital mortality compared with not having a TTE (p=0.7).
Conclusions: The study highlights the low pre-operative utilization rate of NST and the surprisingly high rate of TTE in older patients admitted with hip fracture. The use of TTE was associated with increased TTS with no effect on mortality or TTD. Further studies must further clarify the role of TTE in the pre-operative evaluation of older adults admitted with acute hip fracture.