Bedeker W.F., Lachman A.S., Borkum M., Hellenberg D., Cupido C.S.
Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, South Africa; Victoria Hospital, Wynberg, Cape Town, South Africa; Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
Bedeker, W.F., Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, South Africa; Lachman, A.S., Victoria Hospital, Wynberg, Cape Town, South Africa; Borkum, M., Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa; Hellenberg, D., Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, South Africa; Cupido, C.S., Victoria Hospital, Wynberg, Cape Town, South Africa
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. Objectives. 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. Conclusion. 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. © 2015, South African Medical Association. All rights reserved.
adolescent; aged; anticoagulant therapy; aorta atherosclerosis; aorta stenosis; aorta valve regurgitation; Article; cardiomegaly; cardiomyopathy; child; cross-sectional study; echocardiograph; faintness; female; health impact assessment; heart aneurysm; heart arrhythmia; heart failure; heart infarction; heart left ventricle function; heart murmur; heart ventricle wall motion; human; ischemic heart disease; male; mitral valve regurgitation; mitral valve stenosis; thorax pain; transthoracic echocardiography; tricuspid valve regurgitation; valvular heart disease; adult; complication; echocardiography; echography; Heart Diseases; middle aged; needs assessment; patient referral; patient selection; preschool child; prospective study; public hospital; South Africa; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cross-Sectional Studies; Echocardiography; Female; Heart Diseases; Hospitals, District; Humans; Male; Middle Aged; Needs Assessment; Patient Selection; Prospective Studies; Referral and Consultation; South Africa; Young Adult