Abstract 16637: Echocardiographic Screening With Remote Reading as a Tool for Additional Cardiovascular Risk Stratification in Primary Care - Data From the PROVAR+ Study

Abstract

Introduction: Morbidity and mortality associated with advanced heart disease (HD) is significant in Brazil. Underserved populations often experience long delays in diagnosis, with long waiting lines for echocardiography (echo). We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation in the Brazilian primary care (PC), and to assess HD prevalence. Methods: In 36 months, 25 healthcare workers at 40 PC units were trained on simplified handheld (GE VSCAN) echo protocols. Screening (SC) groups, including patients aged 17-20, 35-40 and 60-65 years, and patients referred (RF) for clinical indications, in waiting lines, answered a clinical questionnaire and underwent focused echo, interpreted in US and Brazil by telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. A study-derived score including clinical variables (sex, body mass, hypertension, coronary disease, heart failure, heart surgery, valve disease and Chagas disease: low (<13%), intermediate (13% - 69%) and high-risk (≥70%)) was applied to predict HD in echo screening. Results: From January 2017 to November 2019, 4425 patients underwent echo; 1338 (30%) in SC group. Mean age was 54±18 years, 63.7% were females; 57.8% had hypertension and 20.1% diabetes. The most frequent symptoms were chest pain (32.3%), dyspnea (32.3%) and palpitations (25.6%). Significant HD was found in 1409 (31.8%) patients, (28.8% in SC vs. 33.2% in RF group, p=0.004). Comparing SC to RF, severe left ventricular dysfunction was observed in 2.6% vs. 3.1%, p=0.45, severe aortic or mitral regurgitation in 1.5% vs. 1.0%, p=0.17. Prevalence was higher in high-risk patients according to the clinical score, compared to intermediate/low risk (45.3% vs. 26.6%, p<0.001). The continuous risk score was strongly associated with HD (odds ratio=25.8, 95% IC 16.5 - 40.4, p<0.001), with area under ROC curve=0.61. Conclusions: Integration of screening echo into PC is feasible in Brazil as a strategy to prioritize cardiovascular care in low income areas through task-shifting. In association with clinical variables, this tool may improve early diagnosis and referrals.