ASEAN Heart Journal

Intended for healthcare professional

Original Study

ASEAN Heart Journal

January 2019, 26:1

First online: 25 January 2019

Original Study

A Clinical Audit of Transthoracic Echocardiography in Malaysia: A District Hospital Experience

WJ Quah,1 Selvesten Anak Panting,1 T L Fam1
Open Access
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  • Summary
  • Supplementary Material
  • References
  • About this Article


Echocardiography is a very useful tool that is able to aid in the diagnosis of various cardiac diseases. Transthoracic echocardiography in particular provides important valuable cardiac information allowing the clinician to make crucial decisions. Requests for such procedures have been increasing steadily throughout the years. With the growing number of patients and need to handle imaging workload, we now examine the use of echocardiography in a single district hospital with limited resources.


To evaluate and audit the usage of transthoracic echocardiography as an outpatient and inpatient basis.

This was a retrospective, cross-sectional, single center study of all patients that underwent transthoracic echocardiograms in Miri Hospital, Sarawak in the past 1 year from 1st January till 31st December 2017. The only exclusion criteria was patients whom echocardiography were requested but not performed for various reasons. Data retrieval was done by manual collection of echo request forms. SPSS version 21 was used to analyze the data.

Echocardiograms were done for a staggering total of 3196 patients. 1734 (54%) were males while 1462 (46%) were females. There were 1015 inpatients and 2181 outpatients. The age ranged from a month old to 98 years old with mean age of 49 ¬Ī 23. The distribution of ages was skewed left. Based on the total number of patients seen in the hospital, 21% of admitted medical patients had echocardiograms done and 15% of medical clinic patients underwent echocardiograms. Indications vary and include Hypertension (35%), Heart Murmurs Evaluation (12.2%), Acute Coronary Syndrome (12.3%), Pre Chemotherapy (3%), Pre Operative Assessment (1.4%) with the others which were non specific contributing the remaining 36.1%. Sources of referral were mainly from Medical/Nephrology Department (54.4%), Paediatrics (12.2%), District Hospitals/Health Clinics (11.7%), Anaesthesiology (5.3%), Surgery (4.8%), Obstetrics & Gynaecology (3.3%) and the rest (8.3%).

This particular audit indicates that there is room for improvement for the service. We would need to streamline the indications to reduce imaging burden as well as adopt a more pragmatic approach in request for echocardiography in our current setting.


Transthoracic - Echocardiography - Clinical Audit

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1 Department of Internal Medicine, Miri General Hospital at Q353, 98000 Miri, Sarawak, Malaysia (Ministry of Health)

Funding Source: No sponsors / self funding


Open Access: This article is distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0) which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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Supplementary Material




1. Aje A, et al. Audit of Echocardiographic Services at he University College Hospital Ibadan. Niger J Med. 2009 Jan-Mar;18(1):32-4. PubMed

2. Maryanne Caruana, et al. Requesting of Non-Urgent Adult Transthoracic Echocardiograms Online Journal of Clinical Audits, Vol 2, No 4 (2010).

3. Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R et al (2008) European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr vol 9 (4), 438-48. CrossRef  PubMed

4. Douglas PS, Khandheria B, Stainback RF, Weissman NJ (2007) ACCF/ASE/ACEP/ASNC/SCAI/SCCT/ SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography. J Am Coll Cardiol. CrossRef  PubMed 5. British Society of Echocardiography Clinical Indications for Echocardiography . Available from

6. C. Dugo, et al. A Clinical Audit of In-hospital Echocardiography in Heart Failure¬†Heart, Lung and Circulation,¬†2015 Volume 24, S85 ‚Äď S86. CrossRef

7. Rao G, Sainani N, Kusnetzky L, Main M. (2010) Appropriate use of transthoracic echocardiography. Am J Cardiol, Jun 1;105(11), 1640-2. CrossRef

About this Article


A Clinical Audit of Transthoracic Echocardiography in Malaysia: A District Hospital Experience

Open Access

Available under Open Access


>> ASEAN Heart Journal 
>> 25:1

Online Date

21 November 2019



Online ISSN



ASEAN Federation of Cardiology

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Clinical Audit

Author Affiliations

1. Department of Internal Medicine, Miri General Hospital at Q353, 98000 Miri, Sarawak, Malaysia (Ministry of Health)

Funding Source
No sponsors / self funding