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Original research article
Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients
  1. Syed K M Gardezi1,2,
  2. Saul G Myerson1,2,
  3. John Chambers3,
  4. Sean Coffey4,
  5. Joanna d’Arcy1,
  6. F D Richard Hobbs5,
  7. Jonathan Holt6,
  8. Andrew Kennedy1,
  9. Margaret Loudon1,
  10. Anne Prendergast7,
  11. Anthony Prothero1,
  12. Joanna Wilson1,
  13. Bernard D Prendergast3
  1. 1Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
  3. 3Department of Cardiology, St Thomas’ Hospital, London, UK
  4. 4Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  5. 5Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, UK
  6. 6Bicester Health Centre, Bicester, UK
  7. 7Donnington Health Centre, Oxford, UK
  1. Correspondence to Dr Bernard D Prendergast, Department of Cardiology, St Thomas’ Hospital, London SE1 7EH, UK; bernard.prendergast{at}gstt.nhs.uk

Abstract

Objective Cardiac auscultation is a key clinical skill, particularly for the diagnosis of valvular heart disease (VHD). However, its utility has declined due to the widespread availability of echocardiography and diminishing emphasis on the importance of clinical examination. We aim to determine the contemporary accuracy of auscultation for diagnosing VHD in primary care.

Methods Cardiac auscultation was undertaken by one of two experienced general practitioners (primary care/family doctors) in a subset of 251 asymptomatic participants aged >65 years undergoing echocardiography within a large community-based screening study of subjects with no known VHD. Investigators were blinded to the echocardiographic findings. Newly detected VHD was classified as mild (mild regurgitation of any valve or aortic sclerosis) or significant (at least moderate regurgitation or mild stenosis of any valve).

Results Newly identified VHD was common, with mild disease in 170/251 participants (68%) and significant disease in 36/251 (14%). The sensitivity of auscultation was low for the diagnosis of mild VHD (32%) but slightly higher for significant VHD (44%), with specificities of 67% and 69%, respectively. Likelihood ratios were not statistically significant for the diagnosis of either mild or significant VHD in the overall cohort, but showed possible value for auscultation in non-overweight subjects (body mass index <25 kg/m2).

Conclusion Cardiac auscultation has limited accuracy for the detection of VHD in asymptomatic patients and is a poor diagnostic screening tool in primary care, particularly for overweight subjects. Ensuring easy access to echocardiography in patients with symptoms suggesting VHD is likely to represent a better diagnostic strategy.

  • primary care
  • valvular heart disease
  • health care economics
  • quality and outcomes of care

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Footnotes

  • Contributors The study was conceived by BDP and SC. JH and AP performed the initial auscultation. AP acquired the subsequent electronic recording of the heart sounds. Analysis of the recorded heart sounds was performed by ML and Jd’A; and data analysis was performed by SKMG, AK, SGM and JW. The manuscript was drafted by SKMG and SGM and all authors have critically reviewed the manuscript.

  • Funding Supported by the National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The OxVALVE study has approval from the South Central—Hampshire A Research Ethics Committee, REC reference: 09/H0502/58.

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

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