title: Hand-held cardiac ultrasound screening performed by family doctors with remote expert support interpretation.
abstract: OBJECTIVE
  To assess the usefulness of hand-held cardiac ultrasound (HCU) performed by family doctors (FDs) in primary care, with web-based remote expert support interpretation, in a cohort of patient with symptoms or physical examination signs suggestive of cardiovascular disease.
  
  
  METHODS
  This prospective observational study included 1312 consecutive patients, in three remote primary care areas, with symptoms or physical examination signs suggestive of cardiovascular disease. In 859 patients (group A), FDs had indicated conventional echocardiography (CE), and in 453 (Group B) the study was performed to complement the physical examination. HCU was carried out by 14 FDs after a short training period. The scans and preliminary FD reports were uploaded on a web-based program for remote expert support interpretation in <24 h.
  
  
  RESULTS
  Experts considered HCU to be inconclusive in 116 (8.8%) patients. FD and expert agreement on diagnosis was moderate (K=0.40-0.70) except in mitral stenosis (K=0.29) and in left atrial dilation (K=0.38). Diagnostic agreement between expert interpretation and CE was good (K=0.66-0.85) except in mitral stenosis (K=0.43). After remote expert interpretation, conventional echocardiograms were finally requested by FDs in only 276 (32.1%) patients, and discharges increased by 10.2%. Furthermore, significant heart diseases were diagnosed in 32 (7%) patients of group B.
  
  
  CONCLUSIONS
  HCU performed at the point of care by FDs with remote expert support interpretation using a web-based system is feasible, rapid and useful for detecting significant echocardiographic abnormalities and reducing the number of unnecessary echocardiographic studies.
authors.affiliation: Servei de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Servei de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Valentina
authors.initials: V
authors.lastname: Galuppo
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Méndez
authors.affiliation: SAP Delta, L'Hospitalet de Llobregat, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Evangelista
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Arpal
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Rubio
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Vergara
authors.affiliation: SAP Delta, L'Hospitalet de Llobregat, Spain.
authors.forename: Manuela
authors.initials: M
authors.lastname: Liceran
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: López
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sales
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Vicens
authors.initials: V
authors.lastname: Miralles
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Galinsoga
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Pérez
authors.affiliation: SAP Muntanya, Barcelona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Arteaga
authors.affiliation: SAP Delta, L'Hospitalet de Llobregat, Spain.
authors.forename: Betlem
authors.initials: B
authors.lastname: Salvador
authors.affiliation: Hospital de Vielha, Lleida, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: López
authors.affiliation: Servei de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000295:instrumentation / Q000379:methods*; D004502:Education, Medical, Continuing; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D007318:Inservice Training; D020407:Internet; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010821:Physicians, Family / Q000193:education; D019095:Point-of-Care Systems; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011379:Prognosis; D011446:Prospective Studies; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results; D019035:Rural Health Services; D013030:Spain; D014159:Transducers; D019564:Unnecessary Procedures; D055815:Young Adult