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Open access echocardiography in management of heart failure in the community
C M Francis1, L Caruana, P Kearney
1Department of Cardiology, Western General Hospital, Edinburgh.
Insights
An open access echocardiography service effectively supported general practitioners, guiding management changes for over two-thirds of referred patients with suspected heart conditions. This service improved diagnostic accuracy for left ventricular systolic dysfunction.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Primary Care Medicine
Background:
- General practitioners require efficient diagnostic tools for suspected heart failure.
- Access to specialized cardiac imaging, such as echocardiography, can be limited in primary care settings.
- Timely assessment of left ventricular systolic dysfunction is crucial for effective patient management.
Purpose of the Study:
- To evaluate the clinical utility and impact of a newly established open access echocardiography service.
- To determine how the service influenced clinical decision-making in primary care for patients with potential cardiac issues.
Main Methods:
- A prospective study was conducted at a regional cardiology center.
- General practitioners referred patients for echocardiography based on specific clinical criteria.
- Outcomes assessed included the presence of left ventricular systolic dysfunction and subsequent changes in patient management.
Main Results:
- Over five months, 259 patients were referred, with 32 deemed inappropriate referrals.
- Among treated patients, significant findings included left ventricular systolic dysfunction (31) and valvular disease (5).
- Management recommendations, including medication adjustments and diuretic cessation, were made for a substantial proportion of patients.
Conclusions:
- The open access echocardiography service demonstrated significant value by facilitating timely diagnosis and management adjustments.
- The service was well-utilized by general practitioners, leading to improved patient care pathways.
- Echocardiography referrals prompted changes in management for over two-thirds of patients, highlighting the service's clinical impact.
Objective:
To assess the value of an open access echocardiography service.
Design:
Study of new open access service for general practitioners, who were invited to refer patients taking diuretics for suspected heart failure, untreated patients with symptoms of possible heart failure, and asymptomatic patients with risk factors for left ventricular systolic dysfunction.
Setting:
Regional cardiology centre.
Subjects:
259 consecutive patients.
Main Outcome Measures:
Presence or absence of left ventricular systolic dysfunction and consequent changes in clinical management.
Results:
119 treated patients, 99 untreated patients, and nine asymptomatic patients were referred over five months. 32 were considered to be inappropriately referred. Among the treated patients, 31 had impaired left ventricular systolic function and five had valvular disease; angiotensin converting enzyme inhibitors were recommended for 34 of these patients. In addition, 53 were thought not to need diuretics. Eight untreated patients had impaired systolic function and six valvular disease.
Conclusions:
The service was well used by general practitioners and led to advice to change management in more than two thirds of patients.