Abstract 14693: Combined Tele-Cardiology Tools for Cardiovascular Risk Stratification in Primary Care: Data From the PROVAR+ Study

Abstract

Introduction: Tele-cardiology tools are valuable strategies to improve risk stratification, especially in low-resourced settings. We aimed to evaluate the accuracy of tele-electrocardiography (ECG) in remote sites to predict abnormalities in screening echocardiography (echo) in primary care (PC). Methods: In 17 months, 6 healthcare workers at 16 PC units were trained on simplified handheld (GE VSCAN) echo protocols. Tele-ECGs were recorded with dedicated software with measurement and magnification tools, with final diagnosis by a cardiologist. Consented patients with major ECG abnormalities by the Minnesota code, and a 1:3 sample of individuals without abnormalities underwent a clinical questionnaire and screening echo interpreted remotely. Major heart disease (HD) was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. Association between major ECG and echo abnormalities was assessed by logistic regression, in 4 models: 1): unadjusted, 2): model 1 adjusted for age and sex; 3): model 2 plus cardiovascular risk factors (hypertension and diabetes); 4: model 3 plus history of cardiovascular disease (Chagas, Rheumatic Heart Disease, ischemic heart disease, stroke and heart failure). Results: At total 1,411 patients underwent echo; 1,149 (81%) with major ECG abnormalities. Mean age was 67 (IQR 60-74) years, 51.4% were males; 76.3% had hypertension, 37.7% diabetes and 22.3% ischemic heart disease. Among those with major ECG abnormalities, 78% had abnormal echo. Major ECG abnormalities were associated with a 2.2 higher chance of major HD in echo in bivariate analysis: OR=2.15; (95%CI: 1.76 - 3.39), and remained significant after adjustments in models (p<0.001) 2: OR=2.57 (95%CI 1.84 - 3.65), model 3 (OR=2.52 (95%CI 1.80 - 3.58), and model 4 (OR=2.23 (95%CI 1.59 - 3.19). Age (OR=1.07 (95%CI 1.06 - 1.09), p<0.001) and heart failure (OR=5.18 (95%CI 2.43 - 11.87), p<0.001 were also independent predictors of major HD on echo. Conclusions: Tele-ECG abnormalities increased likelihood of major HD on screening echo, even after adjustments for demographic and clinical variables. The combination of tele-cardiology tools and clinical data may improve risk stratification in PC.