Cardiac Point-Of-Care Ultrasound in Acute Medical Unit: Review of Appropriateness and Utility in a Tertiary Centre

Background: Bedside transthoracic echocardiography (TTE), a point-ofcare ultrasound (POCUS) technique, is increasingly being used in acute medical settings to rapidly assess cardiac function and guide management. However, its growing use raises questions about its potential overuse and clinical appropriateness. This study aimed to evaluate the appropriateness of bedside cardiac TTE performed in the Acute Medical Unit (AMU) of a tertiary hospital in Ireland. Methods: We retrospectively reviewed 93 bedside TTE studies conducted over five months. The appropriateness was assessed using the 2011 ACCF/ASE AUC for echocardiography. We also evaluated the clinical indications, NT-proBNP levels, patient demographics, echocardiographic findings, and subsequent follow-up needs. All statistical analyses were performed using SPSS v22.0. Results: Of the 93 POCUS TTEs, a significant majority (87.1%, 81/93), were deemed appropriate, whereas 12.9% (12/93) were considered inappropriate. Patients in the inappropriate group tended to be younger (median age, 54 vs. 72 years; p = 0.062). NT-proBNP levels were notably higher in the appropriate group (median, 862 pg/mL vs. 56 pg/mL, p = 0.032). Inappropriate indications frequently included syncope (42%), hypertension (25%), and suspected endocarditis (17%). While significant echocardiographic findings were more common in appropriate cases (38.3% vs. 25.0%, p = 0.525), only a small fraction (10.75%) of the patients required departmental followup imaging. Conclusion: Cardiac POCUS TTE in AMU is appropriate and provides substantial diagnostic value. However, some unnecessary imaging persists, especially in straightforward cases, such as isolated syncope or high blood pressure. By integrating biomarkers such as blood tests and establishing clear referral processes, we can obtain more accurate diagnostic information and avoid unnecessary scans.