Dos Santos Jonathan, Ribeiro José, Gonçalves Francisco R, Gonçalves Alexandra
Faculty of Medicine, University of Porto, Porto 4200-319, Portugal.
CINTESIS, Center for Health Technology and Services Research, Porto 4200-450, Portugal.
Fam Pract. 2025 Aug 14;42(5). doi: 10.1093/fampra/cmaf068.
Primary healthcare centers (PHC) play a pivotal role in the first-line management of patients with diabetes and hypertension, major risk factors for heart failure (HF) development. Point-of-care cardiac ultrasound (POCUS), integrated as an extension of the physical examination, holds significant potential to enhance diagnostic accuracy and clinical management in this setting.
Evaluate the impact of POCUS on clinical decision-making in patients with HF and at risk of developing HF in PHC and compare POCUS findings with clinical assessment alone, conventional echocardiography, and electrocardiogram results.
Patients with diabetes, hypertension, or HF symptoms at a PHC underwent POCUS by a trained family physician. The findings were compared with traditional clinical practice. Decisions regarding referral for an echocardiogram or hospital consultation were contrasted with those of two clinicians who do not use POCUS, and the investigator's echocardiographic results were compared with those from conventional echocardiography and electrocardiogram. Data were analyzed using SPSS.
Among 196 patients (66 ± 15 years; 53.6% female), 36.2% had HF symptoms, 89.2% hypertension, and 29.7% diabetes. Investigator requested less echocardiograms (44 vs. 145 and 125) and made less hospital referral (15 vs. 16 and 24). Using POCUS, congestive patients were less than expected (18 vs. 43 cases), and stage B HF patients were more than clinically (44.9% vs. 19.4%). POCUS identified more cases with left ventricular hypertrophy than electrocardiograms (58 vs. 10).
These findings highlight the value of integrating POCUS into routine family physician consultations, particularly for the management of HF and effective risk stratification.
基层医疗中心（PHC）在糖尿病和高血压患者的一线管理中发挥着关键作用，而糖尿病和高血压是心力衰竭（HF）发生的主要危险因素。即时心脏超声检查（POCUS）作为体格检查的延伸，在这种情况下具有显著提高诊断准确性和临床管理水平的潜力。
评估POCUS对基层医疗中心HF患者及有发生HF风险患者临床决策的影响，并将POCUS检查结果与单纯临床评估、传统超声心动图及心电图结果进行比较。
基层医疗中心有糖尿病、高血压或HF症状的患者由经过培训的家庭医生进行POCUS检查。将检查结果与传统临床实践进行比较。将关于转诊进行超声心动图检查或医院会诊的决策与两名不使用POCUS的临床医生的决策进行对比，并将研究者的超声心动图检查结果与传统超声心动图及心电图检查结果进行比较。使用SPSS软件对数据进行分析。
196例患者（年龄66±15岁；女性占53.6%）中，36.2%有HF症状，89.2%有高血压，29.7%有糖尿病。研究者要求进行的超声心动图检查较少（44次对145次和125次），转诊至医院的次数也较少（15次对16次和24次）。使用POCUS检查发现，充血性心力衰竭患者比预期少（18例对43例），B期HF患者比临床评估发现的多（44.9%对19.4%）。POCUS检查发现左心室肥厚的病例比心电图检查更多（58例对10例）。
这些发现凸显了将POCUS纳入家庭医生常规会诊的价值，尤其是在HF管理和有效的风险分层方面。
