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

• Published in: Echo research and practice Vol. 6; no. 3; pp. 71 - 79
• Main Authors: Williams, Catrin, Mateescu, Anca, Rees, Emma, Truman, Kirstie, Elliott, Claire, Bahlay, Bohdana, Wallis, Ailsa, Ionescu, Adrian
• Format: Journal Article
• Language: English
• Published: London Bioscientifica Ltd 01.09.2019; BioMed Central; Springer Nature B.V; BMC
• Subjects: Cardiac Imaging; Cardiology; Cardiovascular disease; costs; hand-held ultrasound; heart valve disease; Medicine & Public Health; Older people; Patients; Point of care testing; screening; Ultrasonic imaging; costs; screening; heart valve disease; hand-held ultrasound
• ISSN: 2055-0464; 2055-0464
• DOI: 10.1530/ERP-19-0011

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.