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Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals
John Chambers1, Saleha Kabir, Eric Cajeat
1Adult Echocardiography, Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Insights
Open access echocardiography frequently reveals significant heart disease, even when not suspected from clinical requests. Targeting high-risk patients could improve detection rates for conditions like valve disease and LV systolic dysfunction.
Area of Science:
- Cardiology
- Medical Imaging
- Public Health
Background:
- Clinical detection of heart disease remains challenging.
- Echocardiography is recommended for patients with potential cardiac symptoms or signs.
Purpose of the Study:
- To analyze the frequency of structural heart disease detected via open access echocardiography over two years.
- To evaluate the utility of echocardiography based on clinical request indications.
Main Methods:
- Retrospective analysis of 2343 open access transthoracic echocardiograms performed between January 2011 and December 2012.
- Categorization of echocardiogram reports into normal, minor abnormalities, or significant abnormalities based on indication.
Main Results:
- Significant abnormalities were found in 29% of echocardiograms, including valve disease (13%), LV systolic dysfunction (8%), aortic dilatation (3%), and pulmonary hypertension (4%).
- Targeted echocardiography in high-risk groups could have detected more cases of valve disease and LV systolic dysfunction compared to requests based on isolated murmurs or suspected heart failure.
- Echocardiogram requests were unevenly distributed among general practitioner practices.
Conclusions:
- Open access echocardiography often identifies significant structural heart disease not suspected from initial clinical requests.
- The patchy uptake by general practices suggests a need for better service integration.
- A targeted approach to echocardiography, focusing on patients with a high probability of heart disease, is likely to enhance the detection of clinically significant pathology.
Background:
Heart disease is difficult to detect clinically and it has been suggested that echocardiography should be available to all patients with possible cardiac symptoms or signs.
Aim:
To analyse the results of 2 years of open access echocardiography for the frequency of structural heart disease according to request.
Design And Setting:
Retrospective database analysis in a teaching hospital open access echocardiography service.
Method:
Reports of all open access transthoracic echocardiograms between January 2011 and December 2012 were categorised as normal, having minor abnormalities, or significant abnormalities according to the indication.
Results:
There were 2343 open access echocardiograms performed and there were significant abnormalities in 29%, predominantly valve disease (n = 304, 13%), LV systolic dysfunction (n = 179, 8%), aortic dilatation (n = 80, 3%), or pulmonary hypertension (n = 91, 4%). If echocardiography had been targeted at a high-risk group, 267 with valve disease would have been detected (compared to 127 with murmur alone) and 139 with LV systolic dysfunction (compared to 91 with suspected heart failure alone). Most GP practices requested fewer than 10 studies, but 6 practices requested over 70 studies.
Conclusion:
Open access echocardiograms are often abnormal but structural disease may not be suspected from the clinical request. Uptake by individual practices is patchy. A targeted expansion of echocardiography in patients with a high likelihood of disease is therefore likely to increase the detection of clinically important pathology.
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