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Murmur clinic: validation of a new model for detecting heart valve disease
OBJECTIVES: We aimed to determine if auscultation or a point-of-care scan could reduce the need for standard echocardiography (transthoracic echocardiogram (TTE)) in community patients with asymptomatic murmurs. METHODS: Requests from general practitioners were directed to a new murmur clinic. Auscu...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317436/ https://www.ncbi.nlm.nih.gov/pubmed/30049836 http://dx.doi.org/10.1136/heartjnl-2018-313393 |
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author | Draper, Jane Subbiah, Sheila Bailey, Rikki Chambers, John B |
author_facet | Draper, Jane Subbiah, Sheila Bailey, Rikki Chambers, John B |
author_sort | Draper, Jane |
collection | PubMed |
description | OBJECTIVES: We aimed to determine if auscultation or a point-of-care scan could reduce the need for standard echocardiography (transthoracic echocardiogram (TTE)) in community patients with asymptomatic murmurs. METHODS: Requests from general practitioners were directed to a new murmur clinic. Auscultation and a point-of-care scan were performed by a cardiologist between 1 October 2013 and 31 December 2014 and by a scientist between 21 July 2015 and 9 May 2017. RESULTS: In the first phase (cardiologist), there were 75 patients, mean age 54 (56 women), and in the second phase there were 100 patients, mean age 60 (76 women). In the total population of 175, abnormalities were shown on TTE in 52 (30%), on point-of-care scan in 52 (30%) and predicted on auscultation in 45 (26%) (p=0.125; 95% CI −0.02 to 0.29). The sensitivity of auscultation was not significantly different for the cardiologist (91%) as for the scientist (83%) (p=0.18; 95% CI −0.22 to 0.175) and the specificity was 100% for both. Accuracy was 97% for the cardiologist and 95% for the scientist. For the point-of-care scan, the sensitivity, specificity, positive and negative predictive values and accuracy were 100% for both cardiologist and scientist. CONCLUSION: Most patients in a specialist murmur clinic had normal auscultation and point-of-care scans and no additional valve disease was detected by standard echocardiography. This suggests that a murmur clinic is a valid model for reducing demand on hospital echocardiography services. |
format | Online Article Text |
id | pubmed-6317436 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-63174362019-01-14 Murmur clinic: validation of a new model for detecting heart valve disease Draper, Jane Subbiah, Sheila Bailey, Rikki Chambers, John B Heart Valvular Heart Disease OBJECTIVES: We aimed to determine if auscultation or a point-of-care scan could reduce the need for standard echocardiography (transthoracic echocardiogram (TTE)) in community patients with asymptomatic murmurs. METHODS: Requests from general practitioners were directed to a new murmur clinic. Auscultation and a point-of-care scan were performed by a cardiologist between 1 October 2013 and 31 December 2014 and by a scientist between 21 July 2015 and 9 May 2017. RESULTS: In the first phase (cardiologist), there were 75 patients, mean age 54 (56 women), and in the second phase there were 100 patients, mean age 60 (76 women). In the total population of 175, abnormalities were shown on TTE in 52 (30%), on point-of-care scan in 52 (30%) and predicted on auscultation in 45 (26%) (p=0.125; 95% CI −0.02 to 0.29). The sensitivity of auscultation was not significantly different for the cardiologist (91%) as for the scientist (83%) (p=0.18; 95% CI −0.22 to 0.175) and the specificity was 100% for both. Accuracy was 97% for the cardiologist and 95% for the scientist. For the point-of-care scan, the sensitivity, specificity, positive and negative predictive values and accuracy were 100% for both cardiologist and scientist. CONCLUSION: Most patients in a specialist murmur clinic had normal auscultation and point-of-care scans and no additional valve disease was detected by standard echocardiography. This suggests that a murmur clinic is a valid model for reducing demand on hospital echocardiography services. BMJ Publishing Group 2019-01 2018-07-26 /pmc/articles/PMC6317436/ /pubmed/30049836 http://dx.doi.org/10.1136/heartjnl-2018-313393 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Valvular Heart Disease Draper, Jane Subbiah, Sheila Bailey, Rikki Chambers, John B Murmur clinic: validation of a new model for detecting heart valve disease |
title | Murmur clinic: validation of a new model for detecting heart valve disease |
title_full | Murmur clinic: validation of a new model for detecting heart valve disease |
title_fullStr | Murmur clinic: validation of a new model for detecting heart valve disease |
title_full_unstemmed | Murmur clinic: validation of a new model for detecting heart valve disease |
title_short | Murmur clinic: validation of a new model for detecting heart valve disease |
title_sort | murmur clinic: validation of a new model for detecting heart valve disease |
topic | Valvular Heart Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317436/ https://www.ncbi.nlm.nih.gov/pubmed/30049836 http://dx.doi.org/10.1136/heartjnl-2018-313393 |
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