Aladham, Raed

AbstractBackgroundGoal directed point of care ultrasound (POCUS) is a bedside tool to assist with clinical diagnosis. We examined the impact of POCUS performed by consulting cardiologist (CC) during initial cardiology consult on clinical management and downstream testing.MethodsSixty‐nine study patients (pts) seen in a general cardiology outpatient clinic of a tertiary center by an expert imaging CC were compared to a control group of 65 pts seen by three different CCs without POCUS during the same time‐period, in whom the first standard echo (SE) was performed after the initial visit.ResultsBaseline characteristics were similar between the two groups for age, cardiac risk factors, and referral diagnoses. Echo findings on POCUS and by SE (mean delay of 17.2 days after visit) in the control group were comparable for RV size and function and for valvular heart disease. More patients with lower LVEF, higher LV filling pressures, new regional wall motion abnormalities, and increased aortic root size were present among POCUS group resulting in greater yield of echo abnormalities. There were more cardiovascular medication changes at the first visit (15.3% vs. 5.7%, p < .01), less referral for noninvasive stress testing (10% vs. 29%, p < .01), more advanced cardiac testing and subspecialty referrals (29% vs. 18% pts, p = .06), in the study compared to the control group after cardiology visit.ConclusionPOCUS at time of consultation detects more abnormal echo findings, results in more medication adjustments, less referral for noninvasive stress testing, earlier referral for advanced cardiac diagnostic imaging, and subspecialty cardiac referrals.

Background: Goal directed point of care echo (POCE) has emerged as a quick, bedside tool to assess cardiac structure and function. However, impact of physician performed POCE during cardiac consultation on immediate patient diagnosis, downstream testing and management has not been assessed. Purpose: To study the impact of POCE performed by consulting cardiologist (CC) during initial cardiology consult. Methods: 69 study patients (pts) underwent examination by an expert imaging CC from Jan 2014-May 2016. During 1-hour consultation, medical records were reviewed, medical history and physical exam was performed followed by cardiologist-performed POCE (Philips CX50). We included a matched control group of 65 pts seen by 3 different CCs during the same time period who underwent standard echo (Secho) up to 3 months after the initial visit. Results: Baseline characteristics were comparable between the two groups for age (mean of 62 ) , cardiac risk factors, and referral diagnoses. POCE findings and Secho (mean delay of 17.2 days after visit) are shown in Table1 and diagnostic tests ordered following initial visit in both groups in Figure 1. POCE had greater yield of echo abnormalities and led to less referral for noninvasive stress testing, more cardiovascular medication changes (15.3 vs 5.7% pts) and more advanced cardiac testing (21 vs 9% pts) compared to the control group after the initial visit. Conclusion: Focused echo at time of consultation leads to more medication adjustments, less referral for noninvasive stress testing, earlier referral for advanced cardiac diagnostic imaging and shortens time to advanced diagnostic workup by about two weeks.