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Valvular heart disease
Original research article
Murmur clinic: validation of a new model for detecting heart valve disease
  1. Jane Draper,
  2. Sheila Subbiah,
  3. Rikki Bailey,
  4. John B Chambers
  1. Cardiothoracic Centre, Guy’s and St Thomas’ Hospitals, London, UK
  1. Correspondence to Professor John B Chambers, Cardiothoracic Centre, St Thomas’ Hospital, London SE1 7EH, UK; john.chambers{at}gstt.nhs.uk

Abstract

Objectives We aimed to determine if auscultation or a point-of-care scan could reduce the need for standard echocardiography (transthoracic echocardiogram (TTE)) in community patients with asymptomatic murmurs.

Methods Requests from general practitioners were directed to a new murmur clinic. Auscultation and a point-of-care scan were performed by a cardiologist between 1 October 2013 and 31 December 2014 and by a scientist between 21 July 2015 and 9 May 2017.

Results In the first phase (cardiologist), there were 75 patients, mean age 54 (56 women), and in the second phase there were 100 patients, mean age 60 (76 women). In the total population of 175, abnormalities were shown on TTE in 52 (30%), on point-of-care scan in 52 (30%) and predicted on auscultation in 45 (26%) (p=0.125; 95% CI −0.02 to 0.29). The sensitivity of auscultation was not significantly different for the cardiologist (91%) as for the scientist (83%) (p=0.18; 95% CI −0.22 to 0.175) and the specificity was 100% for both. Accuracy was 97% for the cardiologist and 95% for the scientist. For the point-of-care scan, the sensitivity, specificity, positive and negative predictive values and accuracy were 100% for both cardiologist and scientist.

Conclusion Most patients in a specialist murmur clinic had normal auscultation and point-of-care scans and no additional valve disease was detected by standard echocardiography. This suggests that a murmur clinic is a valid model for reducing demand on hospital echocardiography services.

  • murmur
  • echocardiography
  • point of care scan
  • auscultation
  • general practice

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2018-313393

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    Footnotes

    • Contributors JD collected data in the first phase and wrote the first draft. SS collected data in the second phase, contributed to data analysis and contributed to revisions of the article. RB collected data in the second phase and contributed to the revision of the paper. JBC designed the study, collected data in the first phase and contributed significantly to the analysis of the data and to writing the finished draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Trust audit office (number 5077).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There is no additional information.