title: American Society of Echocardiography: Remote Echocardiography with Web-Based Assessments for Referrals at a Distance (ASE-REWARD) Study.
abstract: BACKGROUND
  Developing countries face the dual burden of high rates of cardiovascular disease and barriers in accessing diagnostic and referral programs. The aim of this study was to test the feasibility of performing focused echocardiographic studies with long-distance Web-based assessments of recorded images for facilitating care of patients with cardiovascular disease.
  
  
  METHODS
  Subjects were recruited using newspaper advertisements and were prescreened by paramedical workers during a community event in rural north India. Focused echocardiographic studies were performed by nine sonographers using pocket-sized or handheld devices; the scans were uploaded on a Web-based viewing system for remote worldwide interpretation by 75 physicians.
  
  
  RESULTS
  A total of 1,023 studies were interpreted at a median time of 11:44 hours. Of the 1,021 interpretable scans, 207 (20.3%) had minor and 170 (16.7%) had major abnormalities. Left ventricular systolic dysfunction was the most frequent major abnormality (45.9%), followed by valvular (32.9%) and congenital (13.5%) defects. There was excellent agreement in assessing valvular lesions (κ = 0.85), whereas the on-site readings were frequently modified by expert reviewers for left ventricular function and hypertrophy (κ = 0.40 and 0.29, respectively). Six-month telephone follow-up in 71 subjects (41%) with major abnormalities revealed that 57 (80.3%) had improvement in symptoms, 11 (15.5%) experienced worsening symptoms, and three died.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility of performing sonographer-driven focused echocardiographic studies for identifying the burden of structural heart disease in a community. Remote assessment of echocardiograms using a cloud-computing environment may be helpful in expediting care in remote areas.
authors: Shah Satnam ji Speciality Hospital, Dera Sacha Sauda, Sirsa, Haryana, India.
authors: Shanemeet
authors: S
authors: Singh
authors: Manish
authors: M
authors: Bansal
authors: Puneet
authors: P
authors: Maheshwari
authors: David
authors: D
authors: Adams
authors: Shantanu P
authors: SP
authors: Sengupta
authors: Rhonda
authors: R
authors: Price
authors: Leaanne
authors: L
authors: Dantin
authors: Mark
authors: M
authors: Smith
authors: Ravi R
authors: RR
authors: Kasliwal
authors: Patricia A
authors: PA
authors: Pellikka
authors: James D
authors: JD
authors: Thomas
authors: Jagat
authors: J
authors: Narula
authors: Partho P
authors: PP
authors: Sengupta
mesh_terms: D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D004452:Echocardiography / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D020407:Internet; D008297:Male; D019114:Remote Consultation; D012955:Societies, Medical