Abstract:
Background : Despite continued efforts, the majority of patients
with valvular heart disease (VHD) remain undiagnosed and untreated. This
study aimed to assess the adoptability and accuracy of point-of-care
handheld echocardiographic assessments (POCE) in the primary care
setting.
Methods: Eleven previously untrained primary care providers
were trained to use the Vscan Extend (GE, WI) POCE to assess VHD, left
ventricular function (LVEF), and major extra-cardiac findings. Their
assessments were compared to those of 3 blinded expert readers. A total
of 180 assessments were evaluated using Kappa statistics (κ) together
with their estimated standard error, p-value, and 95% CI bounds.
Results: Identical or nearly identical agreement between
previously untrained primary providers and expert readers was evident
for the diagnosis of tricuspid regurgitation, mitral regurgitation,
pericardial effusion, volume status. These agreements were strongest in
apical long axis (κ =1, p<0.001) and parasternal long and
short axis views (k>=0.82 p<0.001), though
agreement remained robust in apical 4-chamber views
(k>=0.76). The agreements in LVEF assessment were identical
in the apical long axis view (κ =1, p<0.001) and robust in the
remaining 3 views (κ>=0.66, p<0.001). The
assessments of aortic stenosis (parasternal/long, κ =0.42, and
parasternal/short, κ =0.47, both p<0.001) were weak in their
agreement.
Conclusion: Compared to expert echocardiography readers, the
untrained providers’ use of POCE for VHD shows high user adoptability
and diagnostic accuracies in the primary care setting.