Every year, millions of patients with heart disease go undiagnosed or receive delayed treatment. This is not because the tools don’t exist, but because they’re not being used enough. Echocardiography, a non-invasive, life-saving imaging tool, is performed in only 8% of eligible hospitalized patients, despite strong evidence that it reduces mortality and improves outcomes. With heart disease as the world’s leading cause of death, missing early warning signs is not an option. Yet, labor shortages, outdated policies, and limited imaging access continue to restrict echocardiography’s use when it’s needed most. Expanding access to cardiac ultrasound, whether through broader screening, AI-driven automation, or wearable imaging technologies, could revolutionize cardiovascular care, making lifesaving diagnostics available to more patients, faster.
Heart Valve Disease
A study in the European Heart Journal - Cardiovascular Imaging reveals that one in four adults over 60 have undiagnosed heart valve disease, often remaining asymptomatic until severe. Routine echocardiographic screening for this age group could enable timely medical therapy, risk management, and follow-up, reducing long-term complications. Research indicates that early surgical intervention in severe asymptomatic heart valve disease lowers cardiac mortality and morbidity significantly, potentially saving thousands of lives each year. With clinical guidelines already supporting intervention based on echocardiographic findings, broader screening could significantly improve patient outcomes and reduce late-stage cardiovascular disease.
Improved Management of Heart Failure
As a non-invasive imaging tool that provides critical insights into cardiac structure and function, echocardiography is an indispensable part of the management of congestive heart failure. The American Society of Echocardiography (ASE) emphasizes the importance of combining multiple echocardiographic variables to assess left ventricular diastolic and systolic functions accurately. The ASE guidelines identify those parameters as essential for evaluating heart function in patients with structural myocardial disease, with or without reduced ejection fraction. Beyond its role in initial diagnosis, these measures have been directly correlated with patient outcomes, allowing for better risk stratification and treatment planning. By integrating these echocardiographic findings into routine practice, clinicians can more accurately identify high-risk patients and tailor interventions accordingly.
Moreover, echocardiography plays a vital role in monitoring treatment efficacy in heart failure patients. Serial and longitudinal assessments enable clinicians to track changes in ventricular function, chamber sizes, and hemodynamic parameters, ensuring timely adjustments to treatment plans. Though centered on implantable hemodynamic monitoring rather than echocardiography, the CHAMPION trial provided strong evidence that continuous hemodynamic monitoring significantly reduces heart failure hospitalizations by enabling early therapeutic interventions before symptoms worsen. Since echocardiography provides key insights into similar hemodynamic parameters of the heart, incorporating it into routine heart failure management has the potential to enhance risk stratification, proactive intervention, and disease progression monitoring.
Primary Care, Underserved Populations and Remote Monitoring
Point-of-Care UltraSound (POCUS) has been shown to be effective in the early detection of heart failure in primary care settings, thereby improving access for patients who might otherwise lack cardiology follow-up. Some reports indicate that at least 20% of symptomatic heart failure cases go undiagnosed in primary case settings, likely due to lack of proper diagnostic tools. Studies have demonstrated that POCUS is a sensitive and specific tool for diagnosing conditions like congestive heart failure in symptomatic patients.
The Missed Opportunity in Echocardiography
Echocardiography is a life-saving, cost-effective tool, yet it's drastically underused in hospitals worldwide. Despite its ability to guide treatment and reduce mortality, only 8% of eligible patients hospitalized for critical cardiovascular conditions in the United States receive an echocardiogram. This isn’t just a gap in care – it’s a missed opportunity to improve outcomes and reduce costs.
A nationwide study analyzing echocardiography trends between 2001 and 2011 found that while usage increased modestly (3% annually), it remained significantly under-utilized for high-risk conditions such as acute myocardial infarction (AMI), heart failure, stroke, sepsis, and cardiac dysrhythmias. More critically, the study revealed that patients who underwent echocardiography had significantly lower odds of in-hospital mortality: 26% lower for AMI, 64% lower for stroke, 18% lower for heart failure, and 23% lower for sepsis. These numbers make a strong case that more widespread echocardiography could directly improve survival rates.
Beyond its clinical benefits, echocardiography is also a cost-efficient solution for the healthcare system. As highlighted in an accompanying editorial, early echocardiographic assessment helps optimize treatment decisions, reduce hospital stays, and prevent unnecessary interventions, translating into lower overall healthcare costs. Concerns over overuse and cost-cutting measures may have led hospitals to restrict echocardiography, but these policies risk delaying critical diagnoses and worsening patient outcomes.
The fact that only 8% of eligible patients are receiving echocardiograms raises an important question: How much could the echocardiography market grow if access were expanded? With 7.1 million inpatient echocardiograms performed annually in the U.S., expanding access to all eligible patients could mean a 12x increase in demand, potentially reaching over 85 million scans per year. This growth would not only enhance patient care but also create new opportunities for the medical imaging industry, particularly in portable, AI-assisted, and remote echocardiography solutions.
Echocardiography shouldn’t be an afterthought, but rather it should be a standard of care. Expanding its use could save thousands of lives, lower healthcare costs, and unlock significant market potential. It’s time for hospitals, policymakers, and industry leaders to rethink how we integrate echocardiography into routine clinical practice.
The Way Forward
The underutilization of echocardiography is not just a policy issue – it is also driven by a severe shortage of skilled ultrasound technicians. Between 2011 and 2021, the demand for ultrasound examinations surged by 55%, while the workforce of sonographers grew by only 44%, creating a widening gap between need and availability. This labor shortage places significant strain on healthcare systems, making it difficult to expand echocardiography access, particularly in underserved regions.
Despite its life-saving potential, echocardiography remains out of reach for many patients due to workforce shortages, high costs, and infrastructure limitations. But innovation is changing that. Sonus Microsystems is leading this transformation with the novel and breakthrough polymer ultrasound technology – an affordable, automated, and accessible solution designed to eliminate traditional barriers to cardiac imaging. By integrating AI-powered imaging, automation, and wearable ultrasound capabilities, we’re making diagnostics, monitoring, and screening more available where and when they’re needed most.
If you're a clinician, researcher, or healthcare leader looking to expand access to ultrasound imaging, we’d love to connect. Learn how Sonus is revolutionizing echocardiography to bring life-saving diagnostics to more patients - anywhere, anytime.