Abstract 16114: Screening Echocardiography With Remote Reading by Telemedicine as a Risk Stratification Tool 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.A16114-A16114
• Main Authors: Nascimento, Bruno R, Diamantino, Adriana C, Nunes, Maria Do Carmo P, Sable, Craig A, Oliveira, Kaciane, Rabelo, Lara, Barbosa, Marcia, Reese, Alison T, Fraga, Clara, Costa, Waydder, Rezende, Breno, Rios, Joao Pedro, Reis, Susana, Beaton, Andrea Z, Ribeiro, Antonio L
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.16114

IntroductionScreening echocardiography (echo) may be a tool for early diagnosis and rationalization of referrals in primary care (PC), organizing waiting lines. We aimed to evaluate the role of screening echo integrated with the Brazilian PC for prioritization of referrals and risk stratification.MethodsOver 24 months, 22 healthcare workers at 21 PC centers were trained on simplified handheld (GE VSCAN) echo protocols. Screening (SC) groups, including consented patients aged 17-20, 35-40 and 60-65 years, and patients referred (RF) for clinical indications, in waiting lines, answered a clinical questionnaire and underwent focused echo, interpreted remotely in US and Brazil by telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. A study-derived score including clinical variables (sex, body mass, history of hypertension, coronary disease, heart failure, heart surgery, valve disease and Chagas disease) was applied, and the reclassification rates from intermediate (13% to 69%) to high (≥70%) and low (70%) had an overall sensitivity of 73% (95% CI 64 - 80) and specificity of 99% (95% CI 96 - 100) to predict HD in standard echo. Screening echo significantly improved overall score accuracy from 63% (95% CI 59 - 68) to 90% (95% CI 87 - 93).ConclusionsScreening echo in PC is a promising prioritization strategy in low resourced areas, through task-shifting. It’s utilization in combination with clinical variables has good accuracy to predict high risk of significant HD.