Article Text

This article has a correction. Please see:

PDF
Original article
Hand-held cardiac ultrasound screening performed by family doctors with remote expert support interpretation
  1. Arturo Evangelista1,
  2. Valentina Galuppo1,
  3. Judith Méndez2,
  4. Lidia Evangelista3,
  5. Lidia Arpal2,
  6. Carles Rubio2,
  7. Montserrat Vergara2,
  8. Manuela Liceran3,
  9. Francesc López2,
  10. Carlos Sales2,
  11. Vicens Miralles2,
  12. Anna Galinsoga2,
  13. Jordi Pérez2,
  14. Mercedes Arteaga2,
  15. Betlem Salvador3,
  16. Carlos López4,
  17. David García-Dorado1
  1. 1Servei de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  2. 2SAP Muntanya, Barcelona, Spain
  3. 3SAP Delta, L'Hospitalet de Llobregat, Spain
  4. 4Hospital de Vielha, Lleida, Spain
  1. Correspondence to Dr Arturo Evangelista, Servei de Cardiología, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron, Barcelona 119-129.08035, Spain; arturevangelistamasip{at}gmail.com

Abstract

Objective To assess the usefulness of hand-held cardiac ultrasound (HCU) performed by family doctors (FDs) in primary care, with web-based remote expert support interpretation, in a cohort of patient with symptoms or physical examination signs suggestive of cardiovascular disease.

Methods This prospective observational study included 1312 consecutive patients, in three remote primary care areas, with symptoms or physical examination signs suggestive of cardiovascular disease. In 859 patients (group A), FDs had indicated conventional echocardiography (CE), and in 453 (Group B) the study was performed to complement the physical examination. HCU was carried out by 14 FDs after a short training period. The scans and preliminary FD reports were uploaded on a web-based program for remote expert support interpretation in <24 h.

Results Experts considered HCU to be inconclusive in 116 (8.8%) patients. FD and expert agreement on diagnosis was moderate (K=0.40–0.70) except in mitral stenosis (K=0.29) and in left atrial dilation (K=0.38). Diagnostic agreement between expert interpretation and CE was good (K=0.66–0.85) except in mitral stenosis (K=0.43). After remote expert interpretation, conventional echocardiograms were finally requested by FDs in only 276 (32.1%) patients, and discharges increased by 10.2%. Furthermore, significant heart diseases were diagnosed in 32 (7%) patients of group B.

Conclusions HCU performed at the point of care by FDs with remote expert support interpretation using a web-based system is feasible, rapid and useful for detecting significant echocardiographic abnormalities and reducing the number of unnecessary echocardiographic studies.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Correction
    BMJ Publishing Group Ltd and British Cardiovascular Society