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Hand-held cardiac ultrasound examinations performed in primary care patients by nonexperts to identify reduced ejection fraction
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0002-1640-0813
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
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2019 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 19, article id 282Article in journal (Refereed) Published
Abstract [en]

BackgroundEarly identification of patients with reduced left ventricular ejection fraction (LVEF) could facilitate the care of patients with suspected heart failure (HF). We examined if (1) focused cardiac ultrasound (FCU) performed with a hand-held device (Vscan 1.2) could identify patients with LVEF <50%, and (2) the distribution of HF types among patients with suspected HF seen at primary care clinics.MethodsFCU performed by general practitioners (GPs)/GP registrars after a training programme comprising 20 supervised FCU examinations were compared with the corresponding results from conventional cardiac ultrasound by specialists. The agreement between groups of estimated LVEF <50%, after visual assessment of global left ventricular function, was compared. Types of HF were determined according to the outcomes from the reference examinations and serum levels of natriuretic peptides (NT-proBNP).ResultsOne hundred patients were examined by FCU that was performed by 1-4 independent examiners as well as by the reference method, contributing to 140 examinations (false positive rate, 19.0%; false negative rate, 52.6%; sensitivity, 47.4% [95% confidence interval [CI]: 27.3-68.3]; specificity, 81.0% [95% CI: 73.1-87.0]; Cohen's kappa measure for agreement=0.22 [95% CI: 0.03-0.40]). Among patients with false negative examinations, 1/7 had HF with LVEF <40%, while the others had HF with LVEF 40-49% or did not meet the full criteria for HF. In patients with NT-proBNP >125ng/L and fulfilling the criteria for HF (68/94), HF with preserved LVEF (>= 50%) predominated, followed by mid-range (40-49%) or reduced LVEF (<40%) HF types (53.2, 11.7 and 7.4%, respectively).ConclusionsThere was poor agreement between expert examiners using standard ultrasound equipment and non-experts using a handheld ultrasound device to identify patients with reduced LVEF. Asides from possible shortcomings of the training programme, the poor performance of non-experts could be explained by their limited experience in identifying left ventricular dysfunction because of the low percentage of patients with HF and reduced ejection fraction seen in the primary care setting.Trial registrationThe study was registered at ClinicalTrials.gov (NCT02939157). Registered 19 October 2016.

Place, publisher, year, edition, pages
BMC , 2019. Vol. 19, article id 282
Keywords [en]
Echocardiography, Heart failure, Primary care, Clinical trial
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Nursing
Identifiers
URN: urn:nbn:se:umu:diva-161987DOI: 10.1186/s12909-019-1713-9ISI: 000477596100003PubMedID: 31345207OAI: oai:DiVA.org:umu-161987DiVA, id: diva2:1342597
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14Bibliographically approved

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Nilsson, GunnarSamuelsson, EvaMooe, Thomas

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