BACKGROUND: No consensus exists about the use of imaging strategies to identify potential cardiovascular sources of emboli in @entity1 who have had @entity64 . OBJECTIVE: To determine the cost-effectiveness of various cardiac imaging strategies after @entity64 . DESIGN: A markov model decision analysis was used to evaluate the benefits and costs of nine diagnostic strategies, including transthoracic echocardiography, transesophageal echocardiography, sequential approaches, selective imaging, and no imaging. SETTING: Simulated clinical practice in the United States. @entity1 : Hypothetical @entity1 with a first @entity64 who were in normal sinus rhythm. MEASUREMENTS: Echocardiographic detection rates of potential sources of emboli were ascertained by doing a systematic review of the literature. Values for event rates, anticoagulation effects, utilities, and costs were obtained from the literature and Medicare data. RESULTS: When visualized left @entity715 was used as the only indication for anticoagulation, transesophageal echocardiography performed only in @entity1 with a history of cardiac problems cost  9000 per quality-adjusted life-year; transesophageal echocardiography in all @entity1 cost  13,000 per quality-adjusted life-year. Cost savings and decreased morbidity and mortality rates associated with reduction in preventable recurrent @entity64 substantially offset examination costs and risks of anticoagulation. These results were moderately sensitive to efficacy of anticoagulation and incidence of @entity510 during anticoagulation and were mildly sensitive to prevalence of left @entity715 , rate of recurrent @entity64 in @entity1 with @entity715 , quality of life after @entity64 , cost of transesophageal echocardiography, and specificity of transesophageal echocardiography. Transthoracic echocardiography, alone or in sequence with transesophageal echocardiography, was not cost-effective compared with transesophageal echocardiography. CONCLUSION: Physicians should consider doing transesophageal echocardiography in all @entity1 with new-onset @entity64 .

Echocardiographic identification of cardiovascular sources of emboli to guide clinical management of XXXX : a cost-effectiveness analysis.

@entity1 :: ('9606', 'Species') :: ['patients', 'PATIENTS'] @entity715 :: ('MESH:D013927', 'Disease') :: ['atrial thrombus', 'thrombus'] @entity64 :: ('MESH:D020521', 'Disease') :: ['strokes', 'stroke'] @entity510 :: ('MESH:D013345', 'Disease') :: ['intracranial bleeding']
@entity64 :: (MESH:D020521,Disease) :: ['stroke']
