Abstract 13370: Echocardiographic Screening of Pregnant Women by Non-Physicians With Remote Interpretation in Primary Care: Data From the PROVAR+ Study

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A13370-A13370
• Main Authors: Nascimento, Bruno R, Beaton, Andrea Z, Nunes, Maria Do Carmo P, Oliveira, Kaciane K, Diamantino, Adriana C, Rabelo, Lara C, Barbosa, Marcia, Reese, Alison T, Reis, Susana P, Fraga, Clara L, Rezende, Breno D, Costa, Waydder Antônio A, Ribeiro, Antonio L, Sable, Craig A
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.13370

IntroductionDelays in diagnosis of heart disease (HD) associated with pregnancy may impact clinical outcomes. We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation into the Brazilian pre-natal primary care (PC), and to assess HD prevalence.MethodsOver 12 months, 20 healthcare workers were trained to provide simplified echo protocols, utilizing handheld machines (GE VSCAN), in 22 PC centers. Health agents provided house-to house education. Consecutive pregnant women without history of HD underwent focused echo. Studies were interpreted remotely in US and Brazil by telemedicine. Major HD was defined as moderate to severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. Screen-positive women were referred for follow-up standard echo.ResultsFrom Jan/2018 to Jan/2019, 1,112 women underwent echo. Quality issues were reported in 1.5%, not precluding interpretation. Mean age was 27±8 years, mean gestational age 22±9 weeks, 48% were primiparous, 4.5% had hypertension, and 4.6% family history of valve disease. The most frequent symptoms were dyspnea (37.7%) and palpitations (20%). Major HD was found in 100 (9.0%) patients (9.1% in 1 / 2 trimesters vs. 7.5% in 3, p=0.35). Moderate mitral regurgitation (MR) was observed in 47 (4.2%), tricuspid regurgitation in 11 (1.0%), mild left ventricular (LV) dysfunction in 4 (0.4%), LV hypertrophy in 2 (0.2%) and suspected rheumatic heart disease (RHD) in 36 (3.2%)all with mitral valve (MV) and 2 with aortic valve (AV) involvement. Other AV disease was observed in 11 (10%). In 56 screen-positive women undergoing standard echo, major HD was confirmed in 45 (80.4%)RHD findings in 12 patients (all with MV and 2 with AV disease, being 1 AV stenosis), MR in 40 (14 with morphological findings, 10 suggestive of RHD), other AV disease in 2 (mild/moderate regurgitation). Mild LV dysfunction was confirmed in 1 case.ConclusionsIntegration of screening echo into primary pre-natal care is feasible in Brazil. Although the echocardiographic HD burden was considerable, the low prevalence of severe disease requiring clinical attention urges further investigations about the effectiveness of the strategy.