Integration of echocardiographic screening by non-physicians with remote reading in primary care
| Autor: | Bruno R, Nascimento, Andrea Z, Beaton, Maria Carmo Pereira, Nunes, Allison R, Tompsett, Kaciane K B, Oliveira, Adriana C, Diamantino, Márcia M, Barbosa, Tainá V, Lourenço, Isabella M, Teixeira, Gabriela Z L, Ruiz, João Pedro P, Rios, Antonio Luiz P, Ribeiro, Craig, Sable, Zilda Maria, A Meira |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Telemedicine Inservice Training Heart Diseases Heart disease Referral Health Personnel Point-of-Care Systems 030204 cardiovascular system & hematology Pericardial effusion Muscle hypertrophy 03 medical and health sciences Underserved Population 0302 clinical medicine Internal medicine Health care Prevalence medicine Humans Mass Screening Telemetry 030212 general & internal medicine Aged Mitral regurgitation business.industry Middle Aged medicine.disease Quality Improvement Echocardiography Feasibility Studies Female Cardiology and Cardiovascular Medicine business Brazil |
| Zdroj: | Heart. 105:283-290 |
| ISSN: | 1468-201X 1355-6037 |
| Popis: | IntroductionHeart disease (HD) accounts for high morbidity and mortality in Brazil. Underserved populations often suffer long delays in diagnosis. We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation in the established primary care system (PC) in Brazil and to assess HD prevalence.MethodsOver 11 months, 20 healthcare workers (four physicians, four nurses, and 12 technicians) at 16 PC centres were trained on simplified handheld echo protocols. Three screening (SC) groups, including all consented patients aged 17–20, 35–40 and 60–65 years, and patients referred (RF) for clinical indications underwent focused echo. Studies were remotely interpreted through telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, wall-motion abnormalities and congenital heart disease.ResultsTotal 1004 patients underwent echo; 299 (29.8%) in the SC group. Median age was 51±18 years, 63.9% females; 42.7% had cardiovascular symptoms. Significant HD was found in 354 (35.3%) patients (23.4% in SC vs 40.3% in RF group, p60 years (29.2%), compared with 35–40 (14.9%) and under 20 (16.5%), p=0.012. Comparing SC to RF groups, moderate/severe left ventricular dysfunction was observed in 4.1% vs 8.1%, p=0.03, mitral regurgitation in 8.9% vs 20.3%, pConclusionsIntegration focused echo into PC is feasible in Brazil as a strategy to deliver cardiovascular care to low-resourced areas through task shifting. The burden of HD observed suggests this tool may improve early diagnosis and referral. |
| Databáze: | OpenAIRE |
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