Hand-Held Echocardiography by Advanced Practice Providers in Patients with Congestive Heart Failure

Area of Science:

• Cardiology
• Point-of-Care Ultrasound
• Advanced Practice Provider Education

Background:

• Congestive heart failure (CHF) significantly increases hospitalizations and mortality.
• Standard echocardiograms (SE) are crucial for cardiac assessment but often lack immediate availability.
• Rapid assessment of hospitalized CHF patients is vital for prompt treatment initiation.

Purpose of the Study:

• To evaluate the image quality and interpretation accuracy of hand-held echocardiography (HHE) performed by trained advanced practice providers (APPs) in hospitalized CHF patients.
• To compare APP interpretations of HHE with expert echocardiographer assessments and standard echocardiogram (SE) findings.
• To determine the utility of HHE in assessing left ventricular (LV) size, LV ejection fraction (LVEF), and right atrial pressure (RAP).

Main Methods:

• Five trained APPs performed HHE on 80 hospitalized CHF patients over six months.
• APPs interpreted LV size, LVEF, and RAP from HHE images.
• A study echocardiographer blindly reviewed and interpreted HHE images, comparing them with APP and SE findings.
• Kappa statistics and correlation coefficients were used to assess agreement and correlation.

Main Results:

• HHE interpretation by APPs showed good agreement with the study echocardiographer and SE for LVEF (kappa 0.79 and 0.74, respectively).
• Good agreement was observed for RAP interpretation by APPs (kappa 0.67).
• A strong correlation (r = 0.88, p < 0.0001) was found between LVEF assessed by HHE and SE.

Conclusions:

• Trained APPs can acquire diagnostic-quality HHE images for evaluating LV function and RAP in CHF patients.
• HHE interpretation by APPs demonstrates good agreement with expert assessments.
• HHE by trained APPs offers a valuable tool for expedited and optimized CHF patient management.