Suitability and performance of echocardiogram in primary care
Por:
de la Figuera, M, Fernandez, J, Fernandez, MI, Castello, M, Canadell, J
Publicada:
1 abr 2012
Resumen:
Objective: The echocardiogram (ECC) is not available to all Spanish General Practitioners (GP) despite its proven benefits in prevalent diseases, such as hypertension and heart failure.
Study objective: To analyse the clinical adequacy of the application, performance, and diagnostic and therapeutic decisions of ECC indicated by the GP.
Design: Descriptive, cross-sectional, retrospective, multicentre study.
Setting: Primary care. Four health centres (HC).
Participants: A total of 684 patients over 18 years who had an ECC performed in 2006-2007.
Main measurements: A review of medical records and the ECC report. The socio-demographic variables, clinical and diagnostic performance were also evaluated.
Results: The majority of patients (62.3%) were >= 65 years, of which 61.8% were female The most frequent reasons for performing ECC were (but not limited to): heart failure: 30%, suspected valvular disease: 26%; suspected cardiomyopathy: 24.3%. Adequacy of the ECC: 84% (95% CI: 81.09-86.7%) with differences by age (p = .02), HC teaching (p < .001), comorbidity (p < .001) and abnormal ECC (p < .001). A disease was found in 80% of ECC, with differences according to age (p < .001), comorbidity (p = 0.02), cardiovascular risk factors (p < .001) and degree of appropriateness of ECC (p = .001). The most common findings (but not limited to) included: valvular heart disease (61.6%) left ventricular hypertrophy (43%) diastolic dysfunction (28.2%). The results of the ECC helped make decisions in 35.2%, with 17.1% referred to cardiology, 10.5% treatment change and 9.6% other tests.
Conclusions: We found that the application of ECC was highly appropriate. The results of ECC drive clinical decisions in a high percentage of cases. The ECC should be accessible to all GP. (C) 2010 Elsevier Espana, S.L. All rights reserved.
Filiaciones:
de la Figuera, M:
Ctr Atenc Primaria Sardenya, Barcelona, Spain
Fernandez, J:
Ctr Atenc Primaria Besos, Barcelona, Spain
Fernandez, MI:
Serv Atenc Primaria Litoral, Barcelona, Spain
Castello, M:
Ctr Atenc Primaria La Mina, Barcelona, Spain
Canadell, J:
Ctr Atenc Primaria Besos, Barcelona, Spain
Green Published
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