title: Impact of transthoracic echocardiography at district hospital level.
abstract: BACKGROUND
  The use of and demand for echocardiography (ECHO) has increased worldwide. In developed countries, this has not translated into improved access outside tertiary centres. Previous studies have favoured the appropriate use of ECHO over its clinical impact, limiting generalisability to resource-constrained settings.
  
  
  OBJECTIVE
  To assess the impact of an ECHO service at district hospital level in Cape Town, South Africa.
  
  
  METHODS
  A prospective, cross-sectional study was performed. A total of 210 consecutive patients, referred to the ECHO clinic over a 5-month period, were recruited. Transthoracic ECHO was evaluated in terms of its indication, new information provided, correlation with the referring doctor's diagnosis and subsequent management plan. Impact included the escalation and de-escalation of treatment, as well as usefulness without a change in management.
  
  
  RESULTS
  The results show that 83.8% of the patients' management was impacted on by echocardiography. Valvular lesions were the main indication. The most frequent contribution was information provided towards the diagnosis of heart failure and assessment after myocardial infarction. Of the echocardiograms, 56.2% confirmed the referring doctor's diagnosis, yet were still associated with a significant impact. The rational prescription of medication had the major impetus, followed by de-escalation of therapy and screening patients to determine referral to a tertiary facility.
  
  
  CONCLUSIONS
  ECHO has a positive impact on patient management outside tertiary settings, where the definition of impact appears to be different. The value of a normal study, screening prior to upstream referral and usefulness irrespective of change have been established. This should alert policy makers against restriction of access to ECHO and promote training of personnel in its use.
authors.affiliation: Division of Family Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. wfbedeker@gmail.com.
authors.forename: W F
authors.initials: WF
authors.lastname: Bedeker
authors.forename: A S
authors.initials: AS
authors.lastname: Lachman
authors.forename: M
authors.initials: M
authors.lastname: Borkum
authors.forename: D
authors.initials: D
authors.lastname: Hellenberg
authors.forename: C S
authors.initials: CS
authors.lastname: Cupido
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D018579:Patient Selection; D011446:Prospective Studies; D012017:Referral and Consultation; D013019:South Africa; D055815:Young Adult