title: Identification of patients with asymptomatic left ventricular dysfunction: 'real practice' results in primary care.
abstract: OBJECTIVE
  Asymptomatic systolic left ventricular dysfunction (ASLVD) fulfills the essential criteria to screen for a disease. In Italy, echocardiography screening has been suggested for high-risk patients, albeit not tested in 'real practice'.
  
  
  OBJECTIVE
  We evaluated the feasibility and the results of such a strategy in primary care.
  
  
  RESULTS
  Seventy Italian GPs first identified all their 50- to 74-year-old patients with coronary heart disease and/or hypertension and/or diabetes mellitus and/or renal damage, then randomly selected 1405 individuals (one-tenth). In this group, 217 (15%) hypertensive and diabetic patients had no end organ damage evaluation, could not be classified as high/non-high-risk and had no prescription for echocardiogram; 390 individuals [27.7%; 95% confidence interval (CI) 25.4-30%) resulted as high risk. A recent echocardiogram was already available in 129 (33.1%) patients, 122 (31.3%) underwent echocardiography and 139 (35.6%) did not comply with this prescription. Non-compliance and difficult access to echocardiography were the main reasons not to undergo the prescribed echocardiogram. Among the 261 evaluable subjects, 26 (10.8%; 95% CI 7-14.6%) had a <or=50% and 10 (4.0%; 95% CI 1.6-6.4%) a <or=40% left ventricular ejection fraction. Only 5 out of 26 ASLVD cases where detected by echocardiograms performed for pure screening purposes.
  
  
  CONCLUSIONS
  Only a third of high-risk patients may benefit from screening, with a modest gain over current practice in terms of new ASLVD diagnoses.
authors.affiliation: Società Italiana di Medicina Generale (Italian College of General Practitioners), Bisceglie, Italy. d.ambrosio.gaetano@simg.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: D'Ambrosio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Filippi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Labriola
authors.forename: Maria S
authors.initials: MS
authors.lastname: Padula
authors.forename: Claudio
authors.initials: C
authors.lastname: Cricelli
mesh_terms: D000368:Aged; D015897:Comorbidity; D003327:Coronary Disease / Q000150:complications*; D058065:Diabetic Cardiomyopathies; D004452:Echocardiography / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000150:complications*; D008875:Middle Aged; D011320:Primary Health Care; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology