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Acceptability of Cardiovascular Disease Point-of-Care Diagnostics in Primary Care Settings: A Scoping Review
Nakedi Moswete1, Siphesihle Robin Nxele2,3, Penelope Modipane4
1Department of Family Medicine, Faculty of Health Sciences University of Pretoria South Africa.
Insights
Point-of-care testing (POCT) for cardiovascular disease (CVD) shows promise for early diagnosis, especially in low-resource settings. However, more research, particularly randomized trials in low- and middle-income countries, is needed to confirm patient outcomes and effectiveness.
Area of Science:
- Cardiology
- Public Health
- Health Technology Assessment
Background:
- Cardiovascular disease (CVD) is the leading global cause of mortality, disproportionately affecting low- and middle-income countries (LMICs).
- Point-of-care testing (POCT) offers rapid diagnostic results, crucial for resource-limited settings, but investment in CVD POCT lags behind infectious diseases.
- Improving access to screening and early diagnosis is vital to mitigate the global CVD burden.
Purpose of the Study:
- To conduct a scoping review mapping global evidence on the acceptability of CVD POCT.
- To assess CVD POCT acceptability using the World Health Organization's REASSURED criteria.
- To inform future implementation strategies for CVD POCT in diverse healthcare settings.
Main Methods:
- Followed the Arksey and O'Malley framework for the scoping review.
- Conducted a comprehensive literature search across multiple major scientific databases.
- Included 13 primary studies from primary care settings, with quality appraisal using the Mixed Methods Appraisal Tool (MMAT).
Main Results:
- Cardiovascular disease POCTs are generally acceptable to patients and clinicians.
- Emerging themes include POCT availability, impact on clinical decision-making, ease of use, and feasibility.
- Included studies primarily focused on POCT accuracy compared to central labs; only two were randomized controlled trials.
Conclusions:
- CVD POCTs demonstrate potential for clinical integration but require more robust evidence on patient outcomes.
- A significant gap exists in evidence from LMICs, where CVD burden is highest.
- Further randomized controlled trials and economic evaluations in LMICs are essential to support widespread implementation and global CVD reduction strategies.
Background And Aims:
Cardiovascular disease (CVD) remains the leading global cause of death, with 80% of deaths occurring in low- and middle-income countries (LMICs). Improving access to screening and early diagnosis is essential. Point-of-care testing (POCT), which provides rapid results near the patient, is particularly valuable in resource-limited settings. While POCT has been successfully implemented for infectious diseases like HIV and TB, investment in CVD-focused POCT remains limited. This scoping review maps global evidence on the acceptability of CVD POCT, guided by the World Health Organization's REASSURED criteria, to inform future implementation strategies.
Methodology:
This review followed the Arksey and O'Malley framework. A comprehensive search was conducted across PubMed, Scopus, Science Direct, Google Scholar, Web of Science, and EBSCOhost databases. A preliminary search confirmed feasibility. Two reviewers independently screened studies at all stages, with agreement assessed statistically. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT), version 2018.
Results:
Out of 738 articles identified, 13 primary studies conducted in primary care settings were included. Themes emerging from the review included POCT availability, influence on triage and clinical decision-making, ease of use, sample volume, and feasibility. Only two studies were randomized controlled trials; the rest were observational, mostly comparing POCT accuracy to central laboratory testing. Inter-reviewer agreement was high (Kappa = 0.92), and MMAT scores ranged from 71.4% to 85.7%.
Conclusions:
CVD POCTs are generally acceptable and demonstrate strong potential for clinical integration. However, a lack of robust evidence on patient outcomes, particularly from LMICs, limits the establishment of their effectiveness. More randomized controlled trials and economic evaluations in LMICs, where the burden of CVD is highest, are needed to support broader implementation and inform global strategies to reduce the impact of CVD.
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