Handheld echocardiographic screening for rheumatic heart disease by non-experts

Michelle Ploutz, Jimmy C. Lu, Janet Scheel, Catherine Webb, Greg J. Ensing, Twalib Aliku, Peter Lwabi, Craig Sable, Andrea Beaton

Research output: Contribution to journalArticle

Abstract

Objectives Handheld echocardiography (HAND) has good sensitivity and specificity for rheumatic heart disease (RHD) when performed by cardiologists. However, physician shortages in RHD-endemic areas demand less-skilled users to make RHD screening practical. We examine nurse performance and interpretation of HAND using a simplified approach for RHD screening. Methods Two nurses received training on HAND and a simplified screening approach. Consented students at two schools in Uganda were eligible for participation. A simplified approach (HAND performed and interpreted by a non-expert) was compared with the reference standard (standard portable echocardiography, performed and interpreted by experts according to the 2012 World Heart Federation guidelines). Reasons for false-positive and false-negative HAND studies were identified. Results A total of 1002 children were consented, with 956 (11.1 years, 41.8% male) having complete data for review. Diagnoses included: 913 (95.5%) children were classified normal, 32 (3.3%) borderline RHD and 11 (1.2%) definite RHD. The simplified approach had a sensitivity of 74.4% (58.8% to 86.5%) and a specificity of 78.8% (76.0% to 81.4%) for any RHD (borderline and definite). Sensitivity improved to 90.9% (58.7% to 98.5%) for definite RHD. Identification and measurement of erroneous colour jets was the most common reason for false-positive studies (n=164/194), while missed mitral regurgitation and shorter regurgitant jet lengths with HAND were the most common reasons for false-negative studies (n=10/11). Conclusions Non-expert-led HAND screening programmes offer a potential solution to financial and workforce barriers that limit widespread RHD screening. Nurses trained on HAND using a simplified approach had reasonable sensitivity and specificity for RHD screening. Information on reasons for false-negative and false-positive screening studies should be used to inform future training protocols, which could lead to improved screening performance.

Original languageEnglish (US)
Pages (from-to)35-39
Number of pages5
JournalHeart
Volume102
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Rheumatic Heart Disease
Echocardiography
Nurses
Sensitivity and Specificity
Uganda
Mitral Valve Insufficiency
Color
Guidelines
Students
Physicians

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ploutz, M., Lu, J. C., Scheel, J., Webb, C., Ensing, G. J., Aliku, T., ... Beaton, A. (2016). Handheld echocardiographic screening for rheumatic heart disease by non-experts. Heart, 102(1), 35-39. https://doi.org/10.1136/heartjnl-2015-308236

Handheld echocardiographic screening for rheumatic heart disease by non-experts. / Ploutz, Michelle; Lu, Jimmy C.; Scheel, Janet; Webb, Catherine; Ensing, Greg J.; Aliku, Twalib; Lwabi, Peter; Sable, Craig; Beaton, Andrea.

In: Heart, Vol. 102, No. 1, 01.01.2016, p. 35-39.

Research output: Contribution to journalArticle

Ploutz, M, Lu, JC, Scheel, J, Webb, C, Ensing, GJ, Aliku, T, Lwabi, P, Sable, C & Beaton, A 2016, 'Handheld echocardiographic screening for rheumatic heart disease by non-experts', Heart, vol. 102, no. 1, pp. 35-39. https://doi.org/10.1136/heartjnl-2015-308236
Ploutz M, Lu JC, Scheel J, Webb C, Ensing GJ, Aliku T et al. Handheld echocardiographic screening for rheumatic heart disease by non-experts. Heart. 2016 Jan 1;102(1):35-39. https://doi.org/10.1136/heartjnl-2015-308236
Ploutz, Michelle ; Lu, Jimmy C. ; Scheel, Janet ; Webb, Catherine ; Ensing, Greg J. ; Aliku, Twalib ; Lwabi, Peter ; Sable, Craig ; Beaton, Andrea. / Handheld echocardiographic screening for rheumatic heart disease by non-experts. In: Heart. 2016 ; Vol. 102, No. 1. pp. 35-39.
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abstract = "Objectives Handheld echocardiography (HAND) has good sensitivity and specificity for rheumatic heart disease (RHD) when performed by cardiologists. However, physician shortages in RHD-endemic areas demand less-skilled users to make RHD screening practical. We examine nurse performance and interpretation of HAND using a simplified approach for RHD screening. Methods Two nurses received training on HAND and a simplified screening approach. Consented students at two schools in Uganda were eligible for participation. A simplified approach (HAND performed and interpreted by a non-expert) was compared with the reference standard (standard portable echocardiography, performed and interpreted by experts according to the 2012 World Heart Federation guidelines). Reasons for false-positive and false-negative HAND studies were identified. Results A total of 1002 children were consented, with 956 (11.1 years, 41.8{\%} male) having complete data for review. Diagnoses included: 913 (95.5{\%}) children were classified normal, 32 (3.3{\%}) borderline RHD and 11 (1.2{\%}) definite RHD. The simplified approach had a sensitivity of 74.4{\%} (58.8{\%} to 86.5{\%}) and a specificity of 78.8{\%} (76.0{\%} to 81.4{\%}) for any RHD (borderline and definite). Sensitivity improved to 90.9{\%} (58.7{\%} to 98.5{\%}) for definite RHD. Identification and measurement of erroneous colour jets was the most common reason for false-positive studies (n=164/194), while missed mitral regurgitation and shorter regurgitant jet lengths with HAND were the most common reasons for false-negative studies (n=10/11). Conclusions Non-expert-led HAND screening programmes offer a potential solution to financial and workforce barriers that limit widespread RHD screening. Nurses trained on HAND using a simplified approach had reasonable sensitivity and specificity for RHD screening. Information on reasons for false-negative and false-positive screening studies should be used to inform future training protocols, which could lead to improved screening performance.",
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