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Feasibility of focused cardiac ultrasound training for non-cardiologists in a resource-limited setting using a
Benjamin Acheampong1, Joseph R Starnes2, Yaw A Awuku3
1Department of Pediatrics, Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pediatrics, Division of Pediatric Cardiology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Insights
Training non-cardiologists in limited echocardiography significantly improves diagnostic accuracy for heart disease in resource-limited settings. This approach enhances access to crucial cardiac assessments, enabling earlier medical intervention.
Area of Science:
- Cardiology
- Medical Education
- Global Health
Background:
- Heart disease is a major cause of illness and death, especially in low- and middle-income countries.
- Diagnostic tools for heart conditions are often inaccessible in these regions.
- Limited echocardiography by non-specialists can improve diagnosis and treatment access.
Purpose of the Study:
- To assess the feasibility and accuracy of training internal medicine residents in performing and interpreting limited echocardiograms.
- To evaluate the impact of this training on diagnostic capabilities in a resource-limited setting.
Main Methods:
- Two internal medicine residents in Ghana received training in limited echocardiography.
- Trainees performed 50 echocardiograms and interpreted 20 studies each.
- Interpretations were compared against expert assessments at three intervals.
Main Results:
- Diagnostic agreement with experts improved over the training period.
- High agreement was achieved in evaluating left ventricular structure (70%) and function (80%).
- Excellent agreement was observed for right ventricular structure (90%), function (100%), and effusion detection (100%).
Conclusions:
- Non-cardiologists can be effectively trained in focused echocardiography using portable devices.
- This training enhances diagnostic capacity for heart conditions in resource-limited environments.
- Increased access to echocardiography can lead to earlier and more effective medical management.
Background:
Heart disease remains a leading cause of morbidity and mortality, particularly in low- and middle-income countries. Access to diagnostic modalities is limited in these settings. Limited echocardiographic studies performed by non-cardiologists can increase access, improve diagnosis and allow for earlier medical therapy.
Methods:
Two internal medicine residents at a tertiary-level hospital in Ghana were trained to perform limited echocardiographic studies. Each trainee performed 50 echocardiograms and interpreted 20 studies across three predetermined timepoints. Interpretation was compared to expert interpretation.
Results:
Agreement improved over time. At the final evaluation, there was high agreement across all aspects: left ventricular structure (70%, kappa 0.52, p = 0.01), left ventricular function (80%, kappa 0.65, p = 0.004), right ventricular structure (90%, kappa 0.71, p = 0.002), right ventricular function (100%, kappa 1.00, p < 0.001), and presence of effusion (100%, kappa 1.00, p < 0.001).
Conclusions:
Non-cardiologists can be trained in focused echocardiography using handheld machines. Such training can increase access to diagnostic capabilities in resource-limited settings.
