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

Author:

Williams Catrin1,Mateescu Anca2,Rees Emma3,Truman Kirstie4,Elliott Claire5,Bahlay Bohdana5,Wallis Ailsa5,Ionescu Adrian35

Affiliation:

1. 1Hywel Dda LHBCarmarthen, UK

2. 2Director Prof Bogdan PopescuUniversity of Medicine and Pharmacy ‘Carol Davila’ – Euroecolab, Bucharest, Romania

3. 3College of Health SciencesSwansea University, Swansea, UK

4. 4Bay Health NetworkSwansea, UK

5. 5ABMU University NHS TrustMorriston, UK

Abstract

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.

Publisher

Springer Science and Business Media LLC

Subject

Advanced and Specialized Nursing,Radiology, Nuclear Medicine and imaging,Radiological and Ultrasound Technology

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