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The availability of small inexpensive ultrasound devices is a potentially transformative technology. Echocardiography performed at the point-of-care (POC echo) by non-experts might improve diagnosis and management of patients in many clinical settings; examples include evaluation of dyspnea or chest pain in the outpatient clinic, optimization of heart failure therapy in the inpatient setting, and screening large groups of patients in the community such as athletes or those at risk of heart disease. Many cardiology specialists are not supportive of these approaches with the concern that a diagnosis may be missed or incorrect due to suboptimal image acquisition or interpretation. However, POC echo is such a powerful tool that the doubts of cardiovascular specialists will not impede its rapid integration into patient care in every clinical setting. Instead of reacting negatively (and being ignored) to the expansion of echocardiography, we need to actively participate in setting the standards for appropriate training, credentialing, scope-of-practice and quality control for POC echo.
In this issue of Heart, a study by Ploutz and colleagues (see page 35), evaluated the utility of POC echo screening for rheumatic heart disease (RHD) in 956 school children in Uganda. Training in POC echo and a simplified screening protocol for RHD were provided to non-experts in a 4 hour session, followed by 2 days of intensive hands-on experience. Compared to standard imaging by an expert, the sensitivity of non-expert POC echo was about 74% with a specificity of 79% for a borderline or definite diagnosis of RHD. …
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