Nonexpert clinicians trained to screen patients for rheumatic heart disease
Nonexpert clinicians can be trained to help with echocardiographic screening for rheumatic heart disease (RHD), according to new data published in Circulation: Cardiovascular Imaging. However, improved training methods are still needed to improve their specificity and sensitivity.
The study’s authors explained that patients often present with symptoms of RHD when it is too late to treat them quickly and effectively. These late presentations have been associated with heart failure, arrhythmias, cerebrovascular accidents and even infective endocarditis. Screening with echocardiography before the onset of symptoms, research has shown, can help address this issue.
“If RHD is detected on echocardiography, secondary prophylaxis using regular benzyl-benzathine penicillin G injections can be instituted according to guidelines, which may halt progression of RHD by preventing further episodes of group A streptococcal infection and associated acute rheumatic fever,” wrote Dr. Joshua R. Francis, an infectious disease specialist at Menzies School of Health Research in Australia, and colleagues. “Treatment of moderate and severe RHD detected on screening is recommended.”
High costs have been associated with echocardiography screening for asymptomatic RHD—so Francis et al. aimed to see if nonexpert clinicians could be trained to perform the task themselves.
For the team’s analysis, more than 2,500 Australian patients with a median age of 12 years old underwent two echocardiograms—one by “an expert cardiographer” and another by a nonexpert practitioner who underwent a “brief” training session on a handheld ultrasound device. The expert’s data were used as a reference.
Overall, the nonexpert practitioners achieved a sensitivity for definite or borderline RHD of 70.4%. Their specificity, meanwhile, was 78.1%.
“Echocardiographic screening can be used for the early diagnosis of RHD, but implementation has been limited because of resource implications and uncertainty regarding long-term benefits,” the authors concluded. “This study demonstrates that nonexpert practitioners can be trained with to do echocardiographic screening for rheumatic heart disease, achieving moderate sensitivity and specificity. Improvements in training could lead to a feasible nonexpert practitioner led model for rheumatic heart disease screening.”
Read the full study here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.