Point-of-care echocardiographic screening for left-sided valve heart disease: high yield and affordable cost in an elderly cohort recruited in primary practice

Abstract

Background Data about the epidemiology of valvular heart disease (VHD) in the elderly is scarce. Hand-held ultrasound devices (HUDs) enable point-of-care ultrasound scanning (POCUS) but their use in an elderly population has not been reported for VHD screening in primary practice. Methods One hundred consecutive subjects aged >70 years without a VHD diagnosis had 2D and colour Doppler POCUS by an accredited sonographer, using a contemporary HUD (Vscan), in a primary practice setting. Patients with left-sided valve pathology identified by Vscan were referred for formal echo in the local tertiary cardiac centre. Results Mean age (s.d.) was 79.08 (3.74) years (72–92 years); 61 female. By Vscan, we found five patients with ≥moderate aortic stenosis (AS), eight with ≥moderate mitral regurgitation (MR) and none with ≥moderate aortic regurgitation. In the AS and MR groups each, one patient had valve intervention following from the initial diagnosis by Vscan, two and one respectively are under follow-up in the valve clinic, while two and four respectively refused TTE or follow-up. Two patients with moderate MR by Vscan had mild and mild/moderate MR respectively by TTE and were discharged. Total cost for scanning 100 patients was $18,201 – i.e. $182/patient. Conclusions Screening with a hand-held scanner (Vscan), we identified 5/100 elderly subjects who needed valve replacement or follow-up in valve clinic, at a cost of $182/patient. These findings have potential significance for the allocation of resources in the context of an ageing population.

Adoptability and accuracy of point‐of‐care ultrasound in screening for valvular heart disease in the primary care setting

“…Of the 100 patients included, 13 patients had at least moderate AS or moderate MR, and five of the 100 needed a valve replacement or follow-up at a valve clinic based on the findings of the handheld scanner. 14 The handheld scanner allowed for early intervention and referrals for patients. Handheld echocardiography has been shown to be promising in early diagnosis of rheumatic valve disease in children, 15 increasing detection rates of valve disease almost 10-fold compared to clinical examination and auscultation.…”

Adoptability and Accuracy of Point-of-Care Ultrasound in Screening for Valvular Heart Disease in the Primary Care setting

“…Similarly, Williams et al, studied the use of handheld echocardiography in the primary care setting for VHD screening in the elderly population, performed by an experienced sonographer. Of the 100 patients included, 13 patients had at least moderate AS or moderate MR, and five of the 100 needed a valve replacement or follow-up at a valve clinic based on the findings of the handheld scanner (11). The handheld scanner allowed for early intervention and referrals for patients.…”

Impact of Incorporating Echocardiographic Screening into a Clinical Prediction Model to Optimize Utilization of Echocardiography in Primary Care

“…Conversely, for 410 asymptomatic individuals >=65 years-old with at least 1 risk factor for heart failure, comprehensive echo screening with global longitudinal strain added incremental information to clinical parameters to predict incidence of stage-B heart failure 18 . In the UK, among 100 patients >70 years-old without known valve disease undergoing point-of-care echo with the VSCAN, 5% required specialized care or surgery, at a reasonable cost per scan ($182/patient) 19 . Also with an acceptable cost of PS43/scan and PS460 per finding, focused echo screening of 100 young athletes in the UK (6 -18 years) unveiled 12% with indication of further testing 20 .…”