Abstract 18811: Improving the Practicality of Echocardiographic Screening for Rheumatic Heart Disease: Performance of Non-expert Users Following Completion of a Standardized Computer-based Training Curriculum
Background: Echocardiography (echo) is the most sensitive tool for rheumatic heart disease (RHD) detection. However, widespread screening programs are non-existent due to lack of financial and expert human resources in endemic areas. Task-shifting to non-experts to perform RHD screening is promising; however, investigations into workforce composition and replicable training schemes are needed.
Objective: Test non-experts’ ability to conduct RHD screening following a brief, standardized, computer-based training course.
Methods: Six non-experts with a variety of backgrounds (nurses, health technicians, medical students) and echo experience (6 wks-1 yr) completed a 3-module computer-based curriculum focusing on simplified criteria for RHD screening (mitral regurgitation (MR) ≥1.5cm and/or any aortic regurgitation). Following training, two teams of 3 non-experts were placed in school screening environments. Gold-standard diagnoses of RHD (2012, World Heart Federation criteria) were made by cardiologists using standard portable echo equipment. Children diagnosed with RHD and 25% of the general screening population was blindly evaluated by each non-expert using the simplified criteria with handheld echo.
Results: Screening was performed in 1,381 children, with 397 (47 borderline RHD, 6 definite RHD, 336 normal & 8 other) referred for handheld echo (209 Team 1 & 188 Team 2). Age ranged from 5-18 years (mean 13.6); 59% were female. Overall sensitivity of the simplified approach was 90.8% (95% CI 85.4-94.6%; range 75-100%), with an overall specificity of 82.4% (95% CI 79.9-84.7%; range 75-89%). The most common reasons for false-negative screens (n=16) were missed MR (44%) and MR ≤1.5cm (29%), and for false-positive screens (n=179) included identification of erroneous color jets (25%), incorrect MR measurement (24%), and appropriate application of simplified guidelines (MR between 1.5 and 2.0 cm, 39.4%).
Conclusions: A short, computer-based curriculum can be successfully used to train a heterogeneous group of non-experts to preform large-scale RHD screening. This simplified approach addresses prohibitive financial and workforce barriers to widespread RHD screening and holds the potential to significantly reduce the global burden of RHD.
Author Disclosures: A. Beaton: None. B.R. Nascimento: None. A.C. Diamantino: None. G.T. Pereira: None. E.L. Lopes: None. C.O. Miri: None. K.K. Bruno: None. G. Chequer: None. C.G. Ferreira: None. L.C. Lafeta: None. H. Richards: None. L. Perlman: None. C. Webb: None. A.L. Ribeiro: None. C. Sable: None. M.P. Nunes: None.
- © 2015 by American Heart Association, Inc.