Impact of basic transthoracic echocardiography at district hospital level

Master Thesis


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University of Cape Town

The use and demand of echocardiography has increased worldwide. In developed countries, this has not been translated into improved access outside tertiary centres. Previous studies have favoured the appropriate use of echocardiography over its clinical impact, limiting generalisability to resource constrained settings. Objectives: To assess the impact of an echocardiographic service at district hospital level in Cape Town, South Africa. Methods: A prospective, cross-sectional study was performed. A total of 210consecutive patients, referred to the echocardiography clinic over a five-month period, were recruited. Transthoracic echocardiography was evaluated by its indication, new information provided, correlation with referring doctor's diagnosis and subsequent management plan. Impact included the escalation and de-escalation in treatment, as well as usefulness without a change in management. Results: The results show that 84% of the patients' management was impacted by echocardiography. Valvular lesions were the main indication. The most frequent contribution was information provided towards the diagnosis of heart failure and assessment post-myocardial infarction. Fifty-six per cent of the echocardiograms confirming the referring doctor's diagnosis still had a significant impact. The rational prescription of medication had the major impetus, followed by de-escalation of therapy and screening patients for referral to tertiary facilities. Conclusion: Echocardiography has a positive impact on patient management outside tertiary settings, where the definition of impact appears to be different. The value of a normal study, screening prior to upstream referral and usefulness irrespective of change has been established. This should alert policy makers towards the risk of restricted access and promote training.

Includes bibliographical references