Key result
Echocardiography screening for asymptomatic left ventricular dysfunction in high-risk primary care patients yielded a modest diagnostic gain, detecting only 5 of 26 cases (10.8% overall prevalence).
Why the study?
Is echocardiography screening for asymptomatic left ventricular dysfunction feasible and effective in high-risk primary care patients?
Cross-Sectional (n=1,405)
Yes
Is echocardiography screening for asymptomatic left ventricular dysfunction feasible and effective in high-risk primary care patients?
Answers are grounded in this paper and cite their sources.
Echocardiographic screening for asymptomatic left ventricular dysfunction in high-risk primary care patients has low compliance and yields a modest number of new diagnoses compared to current practice.
AIMS: Asymptomatic systolic left ventricular dysfunction (ASLVD) fulfills the essential criteria to screen for a disease. In Italy, echocardiography screening has been suggested for high-risk patients, albeit not tested in 'real practice'. OBJECTIVE: We evaluated the feasibility and the results of such a strategy in primary care. METHODS AND RESULTS: Seventy Italian GPs first identified all their 50- to 74-year-old patients with coronary heart disease and/or hypertension and/or diabetes mellitus and/or renal damage, then randomly selected 1405 individuals (one-tenth). In this group, 217 (15%) hypertensive and diabetic patients had no end organ damage evaluation, could not be classified as high/non-high-risk and had no prescription for echocardiogram; 390 individuals [27.7%; 95% confidence interval (CI) 25.4-30%) resulted as high risk. A recent echocardiogram was already available in 129 (33.1%) patients, 122 (31.3%) underwent echocardiography and 139 (35.6%) did not comply with this prescription. Non-compliance and difficult access to echocardiography were the main reasons not to undergo the prescribed echocardiogram. Among the 261 evaluable subjects, 26 (10.8%; 95% CI 7-14.6%) had a <or=50% and 10 (4.0%; 95% CI 1.6-6.4%) a <or=40% left ventricular ejection fraction. Only 5 out of 26 ASLVD cases where detected by echocardiograms performed for pure screening purposes. CONCLUSION: Only a third of high-risk patients may benefit from screening, with a modest gain over current practice in terms of new ASLVD diagnoses.
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DʼAmbrosio et al. (2010) conducted a cross-sectional in Asymptomatic systolic left ventricular dysfunction (n=1,405). Echocardiography screening was evaluated on Feasibility and results of echocardiography screening strategy in primary care. Echocardiography screening for asymptomatic left ventricular dysfunction in high-risk primary care patients yielded a modest diagnostic gain, detecting only 5 of 26 cases (10.8% overall prevalence).
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