Key result
Point-of-care echocardiographic screening in elderly subjects identified 13% with ≥moderate left-sided valve disease, with 5% needing valve replacement or follow-up at a cost of $182 per patient.
Why the study?
Epidemiological data on valvular heart disease in the elderly is scarce, and point-of-care ultrasound using hand-held devices had not been reported for screening this population in primary practice.
Does point-of-care echocardiographic screening using a hand-held device identify significant left-sided valvular heart disease in elderly patients in primary practice?
Cross-Sectional (n=100)
Does point-of-care echocardiographic screening using a hand-held device identify significant left-sided valvular heart disease in elderly patients in primary practice?
Point-of-care echocardiography using hand-held devices is an affordable and high-yield screening tool for detecting significant undiagnosed valvular heart disease in the elderly.
Supports handheld echo feasibility for elderly primary-care valve screening; leaves open outcome impact and need for prospective trials.
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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Williams et al. (2019) conducted a cross-sectional in Valvular heart disease (n=100). Point-of-care echocardiographic screening (Vscan) was evaluated on Identification of ≥moderate aortic stenosis or mitral regurgitation. Point-of-care echocardiographic screening in elderly subjects identified 13% with ≥moderate left-sided valve disease, with 5% needing valve replacement or follow-up at a cost of $182 per patient.
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