RT Journal Article
SR Electronic
T1 Hand-held cardiac ultrasound screening performed by family doctors with remote expert support interpretation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 376
OP 382
DO 10.1136/heartjnl-2015-308421
VO 102
IS 5
A1 Arturo Evangelista
A1 Valentina Galuppo
A1 Judith Méndez
A1 Lidia Evangelista
A1 Lidia Arpal
A1 Carles Rubio
A1 Montserrat Vergara
A1 Manuela Liceran
A1 Francesc López
A1 Carlos Sales
A1 Vicens Miralles
A1 Anna Galinsoga
A1 Jordi Pérez
A1 Mercedes Arteaga
A1 Betlem Salvador
A1 Carlos López
A1 David García-Dorado
YR 2016
UL http://heart.bmj.com/content/102/5/376.abstract
AB 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.