Open access echocardiography in management of heart failure in the community

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Abstract
Objective: To assess the value of an open access echocardiography service. Design: Study of new open access service for general practitioners, who were invited to refer patients taking diuretics for suspected heart failure, untreated patients with symptoms of possible heart failure, and asymptomatic patients with risk factors for left ventricular systolic dysfunction. Setting: Regional cardiology centre. Subjects: 259 consecutive patients. Main outcome measures: Presence or absence of left ventricular systolic dysfunction and consequent changes in clinical management. Results: 119 treated patients, 99 untreated patients, and nine asymptomatic patients were referred over five months. 32 were considered to be inappropriately referred. Among the treated patients, 31 had impaired left ventricular systolic function and five had valvular disease; angiotensin converting enzyme inhibitors were recommended for 34 of these patients. In addition, 53 were thought not to need diuretics. Eight untreated patients had impaired systolic function and six valvular disease. Conclusions: The service was well used by general practitioners and led to advice to change management in more than two thirds of patients. Key messages Without accurate diagnosis many patients will be treated inappropriately Echocardiography allows rapid confirmation of the diagnosis Providing general practitioners with open access to echocardiography led to a change in treatment being recommended for 70% of patients taking diuretics for suspected heart failure The open access service was popular with general practitioners and did not lead to an unmanageable increase in workload