Focused cardiac ultrasound is feasible in the general practice setting and alters diagnosis and management of cardiac disease.

James Yates,Colin Forbes Royse,Alistair George Royse,Carolyn Royse,David Jeffrey Canty

doi:10.1530/erp-16-0026

Abstract

BackgroundUltrasound-assisted examination of the cardiovascular system with focused cardiac ultrasound by the treating physician is non-invasive and changes diagnosis and management of patient’s with suspected cardiac disease. This has not been reported in a general practice setting.AimTo determine whether focused cardiac ultrasound performed on patients aged over 50 years changes the diagnosis and management of cardiac disease by a general practitioner.Design and settingA prospective observational study of 80 patients aged over 50years and who had not received echocardiography or chest CT within 12months presenting to a general practice.MethodClinical assessment and management of significant cardiac disorders in patients presenting to general practitioners were recorded before and after focused cardiac ultrasound. Echocardiography was performed by a medical student with sufficient training, which was verified by an expert. Differences in diagnosis and management between conventional and ultrasound-assisted assessment were recorded.Results and conclusionEchocardiography and interpretation were acceptable in all patients. Significant cardiac disease was detected in 16 (20%) patients, including aortic stenosis in 9 (11%) and cardiac failure in 7 (9%), which were missed by clinical examination in 10 (62.5%) of these patients. Changes in management occurred in 12 patients (15% overall and 75% of those found to have significant cardiac disease) including referral for diagnostic echocardiography in 8 (10%), commencement of heart failure treatment in 3 (4%) and referral to a cardiologist in 1 patient (1%).Routine focused cardiac ultrasound is feasible and frequently alters the diagnosis and management of cardiac disease in patients aged over 50years presenting to a general practice.

Highlights

Patients frequently present to their general practitioner (GP) with signs and symptoms consistent with heart failure or valvular disease
Physical examination forms an integral part of clinical assessment of cardiac disease and helps direct appropriate tests for definitive diagnosis, but has poor diagnostic accuracy, missing or over-calling clinically important cardiac pathology approximately 50% of the time when compared with transthoracic echocardiography (TTE) in both the acute [4, 5] and outpatient [6, 7] settings
Physicians with brief training are performing their own TTE at the bedside to improve their initial clinical assessment, which improves the initial diagnostic accuracy and influences clinical management [9]. This type of TTE has been recognised and defined by the American Society of Echocardiography as focused cardiac ultrasound (FCU) – “a focused examination of the cardiovascular system performed by a physician by using ultrasound as an adjunct to the physical examination to recognise specific ultrasonic signs that represent a narrow list of potential diagnoses in specific clinical settings” [10]

Summary

Introduction

Patients frequently present to their general practitioner (GP) with signs and symptoms consistent with heart failure or valvular disease. Physicians with brief training are performing their own TTE at the bedside to improve their initial clinical assessment, which improves the initial diagnostic accuracy and influences clinical management [9]. Ultrasound-assisted examination of the cardiovascular system with focused cardiac ultrasound by the treating physician is non-invasive and changes diagnosis and management of patient’s with suspected cardiac disease This has not been reported in a general practice setting. Aim: To determine whether focused cardiac ultrasound performed on patients aged over 50 years changes the diagnosis and management of cardiac disease by a general practitioner. Method: Clinical assessment and management of significant cardiac disorders in patients presenting to general practitioners were recorded before and after focused cardiac ultrasound. Routine focused cardiac ultrasound is feasible and frequently alters the diagnosis and management of cardiac disease in patients aged over 50 years presenting to a general practice

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Conclusion