Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Heart. 2019 Feb;105(4):283-290. doi: 10.1136/heartjnl-2018-313593. Epub 2018 Sep 4.
Heart disease (HD) accounts for high morbidity and mortality in Brazil. Underserved populations often suffer long delays in diagnosis. We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation in the established primary care system (PC) in Brazil and to assess HD prevalence.
Over 11 months, 20 healthcare workers (four physicians, four nurses, and 12 technicians) at 16 PC centres were trained on simplified handheld echo protocols. Three screening (SC) groups, including all consented patients aged 17-20, 35-40 and 60-65 years, and patients referred (RF) for clinical indications underwent focused echo. Studies were remotely interpreted through telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, wall-motion abnormalities and congenital heart disease.
Total 1004 patients underwent echo; 299 (29.8%) in the SC group. Median age was 51±18 years, 63.9% females; 42.7% had cardiovascular symptoms. Significant HD was found in 354 (35.3%) patients (23.4% in SC vs 40.3% in RF group, p<0.001). Prevalence was higher in patients in the SC group aged >60 years (29.2%), compared with 35-40 (14.9%) and under 20 (16.5%), p=0.012. Comparing SC to RF groups, moderate/severe left ventricular dysfunction was observed in 4.1% vs 8.1%, p=0.03, mitral regurgitation in 8.9% vs 20.3%, p<0.001 and aortic stenosis in 5.4% vs 4.3%, p=0.51.
Integration focused echo into PC is feasible in Brazil as a strategy to deliver cardiovascular care to low-resourced areas through task shifting. The burden of HD observed suggests this tool may improve early diagnosis and referral.
心脏病（HD）在巴西导致高发病率和死亡率。服务不足的人群往往在诊断方面存在长时间的延迟。我们旨在评估将筛查超声心动图（echo）与远程解释整合到巴西既定的初级保健系统（PC）中的可行性，并评估 HD 的患病率。
在 11 个月的时间里，16 个 PC 中心的 20 名医疗保健工作者（4 名医生、4 名护士和 12 名技术人员）接受了简化手持式 echo 协议的培训。三个筛查（SC）组包括所有同意的 17-20 岁、35-40 岁和 60-65 岁的患者以及因临床指征转诊（RF）的患者接受了重点超声心动图检查。研究通过远程医疗进行远程解释。显著的 HD 定义为中度/重度瓣膜疾病、心室功能障碍/肥大、心包积液、壁运动异常和先天性心脏病。
共有 1004 名患者接受了超声心动图检查；299 名（29.8%）在 SC 组。中位年龄为 51±18 岁，63.9%为女性；42.7%有心血管症状。在 354 名（35.3%）患者中发现了显著的 HD（23.4%在 SC 组，40.3%在 RF 组，p<0.001）。在年龄>60 岁的 SC 组患者中，患病率较高（29.2%），而 35-40 岁（14.9%）和<20 岁（16.5%）的患病率较低，p=0.012。与 RF 组相比，SC 组中度/重度左心室功能障碍发生率为 4.1%，而 RF 组为 8.1%，p=0.03；二尖瓣反流发生率为 8.9%，而 RF 组为 20.3%，p<0.001；主动脉瓣狭窄发生率为 5.4%，而 RF 组为 4.3%，p=0.51。
将重点超声心动图整合到 PC 中是可行的，可作为通过任务转移向资源匮乏地区提供心血管保健的一种策略。观察到的 HD 负担表明，该工具可能会改善早期诊断和转诊。
