Evaluating the Agreement Between Focused Cardiac Ultrasound in the Emergency Centre and Formal Echocardiography

Background Access to cardiology services and echocardiography is limited in many African settings, creating delays in diagnosis and treatment. Focused cardiac ultrasound (FOCUS), performed at the bedside by non-cardiologists, has potential to bridge this diagnostic need. This study compared the performance of FOCUS against formal echocardiography in identifying key cardiac abnormalities at a district-level hospital in Cape Town, Western Cape Province, South Africa. Methods We retrospectively analysed data from patients who underwent both FOCUS in the emergency centre, and subsequent cardiologist-performed echocardiography. We assessed agreement between modalities for pericardial effusion, left ventricular (LV) systolic function, valvular abnormalities, right ventricular (RV) dilatation, LV regional wall motion abnormalities (RWMA), aortic root enlargement, and large intracardiac masses. We applied descriptive statistics, percentage agreement and Cohen’s Kappa coefficients. Results Forty-four patients were included in this study (median age 55 years, male, 61%). Cardiac failure of varying aetiologies was the most common diagnosis (57%). FOCUS demonstrated high concordance with echocardiography in detecting pericardial effusions (κ >0.77) and large intracardiac masses (κ >0.48). Inter-modality agreement was moderate for RV dilatation and LV RWMA, and fair for valvular abnormalities and LV systolic impairment, with significant discordance observed in several categories. No cases of aortic root enlargement were identified on FOCUS. Conclusion FOCUS performed well in identifying life-threatening or gross abnormalities such as pericardial effusion and intracardiac masses, supporting its utility as a diagnostic tool in resource-limited African settings. However, more nuanced assessments, particularly valvular pathology and subtle ventricular dysfunction, showed variable concordance with echocardiography, underscoring the need for advanced training and a standardised framework for recording assessments. Notwithstanding the limitation of missing data, and temporal delays between investigations, our findings highlight the potential for FOCUS to enhance timely cardiac care at district-level hospitals in low- and middle-income countries, while also emphasising areas where further clinician training and referral pathways remain essential.