Systematic review of open access echocardiography for primary care

Khunti, Kamlesh

doi:10.1016/j.ejheart.2003.10.002

Cited by 29 publications

(26 citation statements)

References 21 publications

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“…16,[19][20][21] However, patients in these studies could also have been referred for analysis of a heart murmur, or for other cardiac causes of breathlessness.…”

Section: Comparison With Other Literaturementioning

confidence: 99%

Overdiagnosis of heart failure in primary care: a cross-sectional study

et al. 2016

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“…16,[19][20][21] However, patients in these studies could also have been referred for analysis of a heart murmur, or for other cardiac causes of breathlessness.…”

Section: Comparison With Other Literaturementioning

confidence: 99%

Overdiagnosis of heart failure in primary care: a cross-sectional study

et al. 2016

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“…Although the value and costbenefit of open-access echocardiography have been the subject of observational studies, they have never been the subject of randomised controlled trials. 6 The four published series found left ventricular systolic dysfunction in only one fifth of referred patients, and diastolic function generally was not assessed. 6 Heart failure (or function) clinics generally provide a onestop approach to diagnosis of heart failure and, as this study shows, have a multidisciplinary approach.…”

Section: Resultsmentioning

confidence: 99%

“…6 The four published series found left ventricular systolic dysfunction in only one fifth of referred patients, and diastolic function generally was not assessed. 6 Heart failure (or function) clinics generally provide a onestop approach to diagnosis of heart failure and, as this study shows, have a multidisciplinary approach. 7 As only a few patients referred prove to have heart failure or left ventricular systolic function, 8 however, such clinics are expensive, and further research is required to compare the cost effectiveness of these differing service models.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and management of patients with heart failure in England

et al. 2008

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-The objective of this postal survey was to assess the services currently accessed by primary care trusts (PCTs) for patients with chronic heart failure. Of the 303 PCTs in England, 225 (74%) responded to the questionnaire. Natriuretic peptides were used by 61 (26%) PCTs, whereas direct access to echocardiography was available to 163 (72%) and heart failure clinics to 95 (42%). Heart failure services were led by a cardiologist in 138 (61%) main referring hospitals, an elderly care physician in 33 (15%), and other physicians in 50 (22%). In total, 138 (62%) PCTs had access to heart failure nurses and 40 (18%) used coronary heart disease nurses; in 13 (5%) PCTs, patients with heart failure were seen by practice nurses. This survey highlights the need for further research on the cost effectiveness of service models for diagnosing and managing heart failure. The evidence base behind heart failure nurses should support their wider availability. The question of who cares for patients with heart failure should be reflected more widely in specialist training programmes in both secondary and primary care.

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“…[20] Although screening of all hypertensive patients has been recommended, as left ventricular hypertrophy itself implies a worse prognosis, [22] others assert that ECHO confirmation would probably not intensify the treatment of the hypertension itself. [22,23] In our study, heart failure was the major indication for ECHO, as was the case in a systematic review of patients referred for OAE from primary care. [23] The role of TTE in providing new information in this context is nonetheless unsurpassed, by detecting LV dysfunction and either establishing or confirming the cause of failure.…”

Section: Fig 2 Upstream Referrals (Impact or Upstream Referral Clinmentioning

confidence: 99%

“…[22,23] In our study, heart failure was the major indication for ECHO, as was the case in a systematic review of patients referred for OAE from primary care. [23] The role of TTE in providing new information in this context is nonetheless unsurpassed, by detecting LV dysfunction and either establishing or confirming the cause of failure. [17] This is of particular value in our setting, where heart failure is usually diagnosed and monitored by clinical means only.…”

Section: Fig 2 Upstream Referrals (Impact or Upstream Referral Clinmentioning

confidence: 99%

Impact of transthoracic echocardiography at district hospital level

et al. 2015

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Background. The use of and demand for echocardiography (ECHO) has increased worldwide. In developed countries, this has not translated into improved access outside tertiary centres. Previous studies have favoured the appropriate use of ECHO over its clinical impact, limiting generalisability to resourceconstrained settings. Objectives. To assess the impact of an ECHO service at district hospital level in Cape Town, South Africa. Methods. A prospective, crosssectional study was performed. A total of 210 consecutive patients, referred to the ECHO clinic over a 5month period, were recruited. Transthoracic ECHO was evaluated in terms of its indication, new information provided, correlation with the referring doctor's diagnosis and subsequent management plan. Impact included the escalation and deescalation of treatment, as well as usefulness without a change in management. Results. The results show that 83.8% of the patients' management was impacted on by echocardiography. Valvular lesions were the main indication. The most frequent contribution was information provided towards the diagnosis of heart failure and assessment after myocardial infarction. Of the echocardiograms, 56.2% confirmed the referring doctor's diagnosis, yet were still associated with a significant impact. The rational prescription of medication had the major impetus, followed by deescalation of therapy and screening patients to determine referral to a tertiary facility. Conclusion. ECHO has a positive impact on patient management outside tertiary settings, where the definition of impact appears to be different. The value of a normal study, screening prior to upstream referral and usefulness irrespective of change have been established. This should alert policy makers against restriction of access to ECHO and promote training of personnel in its use.

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Systematic review of open access echocardiography for primary care

Cited by 29 publications

References 21 publications

Overdiagnosis of heart failure in primary care: a cross-sectional study

Overdiagnosis of heart failure in primary care: a cross-sectional study

Diagnosis and management of patients with heart failure in England

Impact of transthoracic echocardiography at district hospital level

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