Focused cardiac ultrasound is feasible in the general practice setting and alters diagnosis and management of cardiac disease

James Yates, Colin Forbes Royse, Carolyn Royse, Alistair George Royse, David Jeffrey Canty

To determine whether focused cardiac ultrasound changes the diagnosis and management of cardiac disease in patients >50 years assessed by a general practitioner. A prospective observational study of 80 patients aged over 50 years presenting to a general practice who had not received echocardiography or chest CT within 12 months. Clinical assessment and management of significant cardiac disorders of patients presenting to general practitioners were recorded before and after focused cardiac ultrasound. Echocardiography was performed by a medical student with sufficient training and verified by an expert. Differences in diagnosis and management between conventional and ultrasound-assisted assessment were recorded. Echocardiography and interpretation were acceptable in all patients and detected significant cardiac disease in 16 (20%), including aortic stenosis in 9 (11%) and cardiac failure in 7 (9%), which were missed by clinical examination in 10 (62.5%) of these patients. Changes in management occurred in 12 patients (15% overall and 75% of those found to have significant cardiac disease) including referral for diagnostic echocardiography in 8 (10%), commencement of heart failure treatment in 3 (4%) and referral to a cardiologist in 1 patient (1%).Routine focused cardiac ultrasound is feasible and frequently alters diagnosis and management in patients aged over 50 years in general practice.