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

Echo Research & Practice volume 6, pages 71–79 (2019)Cite this article

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.

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Acknowledgments

The authors gratefully thank Prof. Nuno Cardim MD, Hospital da Luz, Lisbon, Portugal, for his valuable editorial comments.

Funding

This study was financed by the Research and Development Department of the Morriston Hospital, ABMU LHB, Swansea, which received an unrestricted grant from Edwards Life Sciences (grant # I 14-312).

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Authors and Affiliations

  1. Hywel Dda LHB, Carmarthen, UK

    Catrin Williams RCCP

  2. University of Medicine and Pharmacy ‘Carol Davila’–Euroecolab, Bucharest, Romania

    Anca Mateescu MD (Director Prof Bogdan Popescu)

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

    Emma Rees PhD & Adrian Ionescu MD DM FRCP

  4. Bay Health Network, Swansea, UK

    Kirstie Truman MD

  5. ABMU University NHS Trust, Morriston, UK

    Claire Elliott RCCP, Bohdana Bahlay RCCP, Ailsa Wallis RCCP & Adrian Ionescu MD DM FRCP

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  1. Catrin Williams RCCP
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Correspondence to Adrian Ionescu MD DM FRCP.

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Williams, C., Mateescu, A., Rees, E. et al. Point-of-care echocardiographic screening for left-sided valve heart disease: high yield and affordable cost in an elderly cohort recruited in primary practice. Echo Res Pract 6, 71–79 (2019). https://doi.org/10.1530/ERP-19-0011

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  • DOI: https://doi.org/10.1530/ERP-19-0011

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Echo Research & Practice

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