Use of hand-held echocardiography to facilitate the management of cardiac disease in older people

Abstract

Access to echocardiography remains suboptimal for many older patients; hand-held echocardiography may improve access to this investigation. New methods of service provision may, however, not always result in appropriate use by clinicians. The aim of this study was to test whether the provision of handheld echocardiography in a geriatric medicine service results in appropriate requests and changes in patient management. The methodology involved in this, was a prospective study of 100 patients referred for hand-held echocardiography in a geriatric medicine service. Information on reason for request, time from request to study, medical history, echocardiography history and medication were collected. Clinicians were asked how results had changed management 7–14 days after the investigation. The mean age of participating patients was 82.6 years. Echo requests were deemed appropriate in 93% of cases. Median time from request to echo was three days for inpatients and 14 days for outpatients. Fifty percent (50/100) of echos led to a change in cardiovascular management; a total of 75 separate changes in cardiovascular management resulted. Seventy-six percent of changes were deemed appropriate; 10% inappropriate and insufficient information was present for 14% of decisions. Provision of hand-held echocardiography allowed rapid investigation of patients for selected abnormalities. Requests were appropriate and appropriate changes to patient management occurred in most patients.