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Impact of transthoracic echocardiography at district hospital level
Abstract
Background. The use of and demand for echocardiography (ECHO) has increased worldwide. In developed countries, this has not
translated into improved access outside tertiary centres. Previous studies have favoured the appropriate use of ECHO over its clinical
impact, limiting generalisability to resource-constrained settings.
Objectives. To assess the impact of an ECHO service at district hospital level in Cape Town, South Africa.
Methods. A prospective, cross-sectional study was performed. A total of 210 consecutive patients, referred to the ECHO clinic over a
5-month period, were recruited. Transthoracic ECHO was evaluated in terms of its indication, new information provided, correlation with
the referring doctor’s diagnosis and subsequent management plan. Impact included the escalation and de-escalation of treatment, as well
as usefulness without a change in management.
Results. The results show that 83.8% of the patients’ management was impacted on by echocardiography. Valvular lesions were the
main indication. The most frequent contribution was information provided towards the diagnosis of heart failure and assessment after
myocardial infarction. Of the echocardiograms, 56.2% confirmed the referring doctor’s diagnosis, yet were still associated with a significant
impact. The rational prescription of medication had the major impetus, followed by de-escalation of therapy and screening patients to
determine referral to a tertiary facility.
Conclusion. ECHO 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 have been established. This
should alert policy makers against restriction of access to ECHO and promote training of personnel in its use.
