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Murmur clinic: validation of a new model for detecting heart valve disease
Jane Draper1, Sheila Subbiah1, Rikki Bailey1
1Cardiothoracic Centre, Guy's and St Thomas' Hospitals, London, UK.
Insights
A specialist murmur clinic using auscultation and point-of-care scans effectively identifies patients without significant valve disease, reducing the need for standard echocardiography (TTE). This model streamlines care for asymptomatic murmurs.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Primary Care
Background:
- Asymptomatic murmurs in community patients often lead to referrals for standard echocardiography (transthoracic echocardiogram - TTE).
- Evaluating the necessity of TTE for these patients is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To assess if clinical auscultation and point-of-care ultrasound scans can decrease the requirement for TTE in community patients presenting with asymptomatic murmurs.
- To validate the efficacy of a dedicated murmur clinic model.
Main Methods:
- A prospective study involving a specialist murmur clinic where patients underwent auscultation and point-of-care scans by a cardiologist and scientist.
- Data collected on diagnostic findings and subsequent TTE results for 175 patients over two phases.
Main Results:
- Auscultation predicted abnormalities in 26% of patients, with high sensitivity (83-91%) and 100% specificity.
- Point-of-care scans demonstrated 100% sensitivity and specificity.
- Both methods showed high accuracy, with TTE confirming abnormalities in only 30% of cases.
Conclusions:
- A specialist murmur clinic utilizing auscultation and point-of-care scans is a valid approach to manage asymptomatic murmurs.
- This model effectively reduces the demand for hospital-based echocardiography services by identifying patients who do not require further investigation.
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.
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