PT  - JOURNAL ARTICLE
AU  - Bruno R Nascimento
AU  - Andrea Z Beaton
AU  - Maria Carmo Pereira Nunes
AU  - Allison R Tompsett
AU  - Kaciane K B Oliveira
AU  - Adriana C Diamantino
AU  - Márcia M Barbosa
AU  - Tainá V Lourenço
AU  - Isabella M Teixeira
AU  - Gabriela Z L Ruiz
AU  - João Pedro P Rios
AU  - Antonio Luiz P Ribeiro
AU  - Craig Sable
ED  - ,
TI  - Integration of echocardiographic screening by non-physicians with remote reading in primary care
AID  - 10.1136/heartjnl-2018-313593
DP  - 2019 Feb 01
TA  - Heart
PG  - 283--290
VI  - 105
IP  - 4
4099  - http://heart.bmj.com/content/105/4/283.short
4100  - http://heart.bmj.com/content/105/4/283.full
SO  - Heart2019 Feb 01; 105
AB  - Introduction Heart disease (HD) accounts for high morbidity and mortality in Brazil. Underserved populations often suffer long delays in diagnosis. We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation in the established primary care system (PC) in Brazil and to assess HD prevalence.Methods Over 11 months, 20 healthcare workers (four physicians, four nurses, and 12 technicians) at 16 PC centres were trained on simplified handheld echo protocols. Three screening (SC) groups, including all consented patients aged 17–20, 35–40 and 60–65 years, and patients referred (RF) for clinical indications underwent focused echo. Studies were remotely interpreted through telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, wall-motion abnormalities and congenital heart disease.Results Total 1004 patients underwent echo; 299 (29.8%) in the SC group. Median age was 51±18 years, 63.9% females; 42.7% had cardiovascular symptoms. Significant HD was found in 354 (35.3%) patients (23.4% in SC vs 40.3% in RF group, p<0.001). Prevalence was higher in patients in the SC group aged >60 years (29.2%), compared with 35–40 (14.9%) and under 20 (16.5%), p=0.012. Comparing SC to RF groups, moderate/severe left ventricular dysfunction was observed in 4.1% vs 8.1%, p=0.03, mitral regurgitation in 8.9% vs 20.3%, p<0.001 and aortic stenosis in 5.4% vs 4.3%, p=0.51.Conclusions Integration focused echo into PC is feasible in Brazil as a strategy to deliver cardiovascular care to low-resourced areas through task shifting. The burden of HD observed suggests this tool may improve early diagnosis and referral.