Abbreviated Echocardiographic Screening for Rheumatic Heart Disease by Nonexperts with and without Offsite Expert Review: A Diagnostic Accuracy Study

Joshua R. Francis, Helen Fairhurst, Jennifer Yan, Anferida Fernandes Monteiro, Anne Marie Lee, Joaquina Maurays, Alex Kaethner, Gillian A. Whalley, Hilary Hardefeldt, Jacqui Williamson, James Marangou, Benjamin Reeves, Gavin Wheaton, Terry Robertson, Ari Horton, James Cush, Vicki Wade, Andre Monteiro, Anthony D.K. Draper, Peter S. MorrisAnna P. Ralph, Bo Remenyi

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
119 Downloads (Pure)

Abstract

Background: Early detection of rheumatic heart disease (RHD) through echocardiographic screening can facilitate early access to effective treatment, which reduces the risk for progression. Accurate, feasible approaches to echocardiographic screening that can be incorporated into routine health services are needed. The authors hypothesized that offsite expert review could improve the diagnostic accuracy of nonexpert-obtained echocardiographic images. Methods: This prospective cross-sectional study was performed to evaluate the diagnostic accuracy of health worker–conducted single parasternal long-axis view with a sweep of the heart using hand-carried ultrasound for the detection of RHD in high-risk populations in Timor-Leste and Australia. In the primary analysis, the presence of any mitral or aortic regurgitation met the criteria for a positive screening result. Sensitivity and specificity were calculated for a screen-and-refer approach based on nonexpert practitioner assessment (approach 1) and for an approach using offsite expert review of nonexpert practitioner–obtained images to decide onward referral (approach 2). Each participant had a reference test performed by an expert echocardiographer on the same day as the index test. Diagnosis of RHD was determined by a panel of three experts, using 2012 World Heart Federation criteria. Results: The prevalence of borderline or definite RHD among 3,329 participants was 4.0% (95% CI, 3.4%-4.7%). The sensitivity of approach 1 for borderline or definite RHD was 86.5% (95% CI, 79.5%-91.8%), and the specificity was 61.4% (95% CI, 59.7%-63.1%). Approach 2 achieved similar sensitivity (88.4%; 95% CI, 81.5%-93.3%) and improved specificity (77.1%; 95% CI, 75.6%-78.6%). Conclusion: Nonexpert practitioner–obtained single parasternal long-axis view with a sweep of the heart images, reviewed by an offsite expert, can detect borderline and definite RHD on screening with reasonable sensitivity and specificity. Brief training of nonexpert practitioners with ongoing support could be used as an effective strategy for scaling up echocardiographic screening for RHD in high-risk settings.

Original languageEnglish
Pages (from-to)733-745
Number of pages13
JournalJournal of the American Society of Echocardiography
Volume36
Issue number7
Early online date18 Feb 2023
DOIs
Publication statusPublished - Jul 2023

Bibliographical note

Funding Information:
This work was supported by Menzies Hot North ( National Health and Medical Research Council grant 1131932 ), the Ricbac Foundation , the Snow Foundation , the Rotary Club of Kiama , Mala’la Health Service , and Medtronic Australasia . Equipment was donated by the Humpty Dumpty Foundation and Mike and Kate Ribot. Additional in-kind support was provided by NT Cardiac , the Starlight Foundation , Maluk Timor , Bakhita Centre , Miwatj Health , and the Northern Territory Department of Health . Dr. Francis is supported by National Health and Medical Research Council investigator award 1194707 , and Dr. Ralph was supported by National Health and Medical Research Council fellowship 1142011 .

Funding Information:
This work was supported by Menzies Hot North (National Health and Medical Research Council grant 1131932), the Ricbac Foundation, the Snow Foundation, the Rotary Club of Kiama, Mala'la Health Service, and Medtronic Australasia. Equipment was donated by the Humpty Dumpty Foundation and Mike and Kate Ribot. Additional in-kind support was provided by NT Cardiac, the Starlight Foundation, Maluk Timor, Bakhita Centre, Miwatj Health, and the Northern Territory Department of Health. Dr. Francis is supported by National Health and Medical Research Council investigator award 1194707, and Dr. Ralph was supported by National Health and Medical Research Council fellowship 1142011.

Publisher Copyright:
© 2023 American Society of Echocardiography

Fingerprint

Dive into the research topics of 'Abbreviated Echocardiographic Screening for Rheumatic Heart Disease by Nonexperts with and without Offsite Expert Review: A Diagnostic Accuracy Study'. Together they form a unique fingerprint.

Cite this