Handheld ultrasound and telemedicine improved general practitioners' correct classification of suspected heart failure from 54% to 74%, whereas automatic quantification added no benefit (p ≥ 0.58).
Observational (n=166)
Does the addition of handheld ultrasound, automatic quantification, and telemedicine improve the diagnostic accuracy of general practitioners in patients with suspected heart failure?
The addition of handheld ultrasound and telemedical support significantly improves the diagnostic precision of general practitioners for suspected heart failure, whereas current automatic quantification tools provide no additional benefit.
Absolute Event Rate: 74% vs 54%
p-value: p=≥0.58
Early and correct heart failure (HF) diagnosis is essential to improvement of patient care. We aimed to evaluate the clinical influence of handheld ultrasound device (HUD) examinations by general practitioners (GPs) in patients with suspected HF with or without the use of automatic measurement of left ventricular (LV) ejection fraction (autoEF), mitral annular plane systolic excursion (autoMAPSE) and telemedical support. Five GPs with limited ultrasound experience examined 166 patients with suspected HF (median interquartile range = 70 (63-78) y; mean ± SD EF = 53 ± 10%). They first performed a clinical examination. Second, they added an examination with HUD, automatic quantification tools and, finally, telemedical support by an external cardiologist. At all stages, the GPs considered whether the patients had HF. The final diagnosis was made by one of five cardiologists using medical history and clinical evaluation including a standard echocardiography. Compared with the cardiologists' decision, the GPs correctly classified 54% by clinical evaluation. The proportion increased to 71% after adding HUDs, and to 74 % after telemedical evaluation. Net reclassification improvement was highest for HUD with telemedicine. There was no significant benefit of the automatic tools (p ≥ 0.58). Addition of HUD and telemedicine improved the GPs' diagnostic precision in suspected HF. Automatic LV quantification added no benefit. Refined algorithms and more training may be needed before inexperienced users benefit from automatic quantification of cardiac function by HUDs.
Magelssen et al. (Fri,) conducted a observational in Suspected Heart Failure (n=166). Handheld ultrasound device (HUD) and telemedicine vs. Clinical evaluation was evaluated on Correct classification of heart failure compared with cardiologists' decision (p=≥0.58). Handheld ultrasound and telemedicine improved general practitioners' correct classification of suspected heart failure from 54% to 74%, whereas automatic quantification added no benefit (p ≥ 0.58).