title: A hand-carried cardiac ultrasound device in the outpatient cardiology clinic reduces the need for standard echocardiography.
abstract: OBJECTIVE
  To assess the potential value and cost-effectiveness of a hand-carried ultrasound (HCU) device in an outpatient cardiology clinic.
  
  
  METHODS
  222 consecutive patients were prospectively enrolled in the study. When standard echocardiography (SE) was specifically indicated on the basis of clinical history, electrocardiogram and physical examination, the same cardiologist (level-2 or level-3 trained) immediately performed an HCU examination. The cardiologist then reassessed the clinical situation to confirm or cancel the SE request according to the information provided by HCU. The SE examination was performed by a sonographer and examined in a blinded fashion by a cardiologist expert in echocardiography. Findings from the two examinations were compared.
  
  
  RESULTS
  HCU was performed in 108/222 patients, and a definite diagnosis was established in 34 of them (31%), making SE examination potentially avoidable. In the 74 patients with inconclusive HCU results and for whom SE was still indicated, the decision was mainly dictated by the lack of spectral Doppler modality in the HCU system. The overall agreement between HCU and SE for diagnosis of normal/abnormal echocardiograms was 73% (kappa = 0.4). On the basis of the potentially avoided SE examinations and the obviated need for a second cardiac consultation, a total cost saving of euro2142 per 100 patients referred for echocardiography was estimated.
  
  
  CONCLUSIONS
  The use of a simple HCU device in the outpatient cardiology clinic allowed reliable diagnosis in one third of the patients referred for echocardiography, which translates into cost and time saving benefits.
authors.affiliation: Department of Cardiology, Policlinico Luigi Di Liegro, Via dei Badoer, 5, 00148 Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Trambaiolo
authors.forename: F
authors.initials: F
authors.lastname: Papetti
authors.forename: A
authors.initials: A
authors.lastname: Posteraro
authors.forename: E
authors.initials: E
authors.lastname: Amici
authors.forename: M
authors.initials: M
authors.lastname: Piccoli
authors.forename: E
authors.initials: E
authors.lastname: Cerquetani
authors.forename: G
authors.initials: G
authors.lastname: Pastena
authors.forename: G
authors.initials: G
authors.lastname: Gambelli
authors.forename: A
authors.initials: A
authors.lastname: Salustri
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D000554:Ambulatory Care Facilities / Q000191:economics; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000191:economics / Q000295:instrumentation* / Q000592:standards; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies