Abstract 20662: Impact of Routine Handheld Focused Cardiac Ultrasonography on the Diagnosis and Management of Hospitalized Cardiac Patients: The CAPITAL FoCUS Registry
Background: History and physical examination remains the basis of initial patient evaluation. Increasingly ultraportable handheld ultrasound units are being utilized to perform focused cardiac ultrasounds (FoCUS) as an adjunct to physical exam in point of care patient assessment. The impact of routine FoCUS studies on the diagnostic assessment and detection of major cardiac abnormalities in a routine inpatient cardiac service has yet to be established.
Methods and Results: A total of 1019 patients at two academic cardiac centers were enrolled in the CAPITAL FoCUS registry. Following history (including laboratory/imaging review) and physical examination a diagnostic list was generated and a management plan outlined. Subsequently, patients underwent a FoCUS scan and imaging findings, change in diagnosis and/or management plan were documented. The primary outcome was correct diagnosis at original assessment. Final diagnosis was determined by full inpatient chart review and adjudicated by two physicians. The primary outcome, correct point of care diagnosis, was achieved in 768 patients following initial history and physical exam and 876 patients following a FoCUS study (75.4% vs. 86.0%, p<0.001). A single patient was reclassified to an incorrect diagnosis following FoCUS. Notably, addition of a FOCUS study was most useful in correctly classifying patients with chest pain syndrome (n=499, 75.6% vs. 84.8%, p<0.001), congestive heart failure (n=108, 76.9% vs. 92.6% p-0.002), pericardial effusion (n=50, 80.0% vs. 96.0%, p=0.03) and shock (n=49, 65.3% vs. 91.9%, p<0.001). Addition of a FoCUS scan was not diagnostically helpful in assessment of patients with arrhythmia (n=94) or patients with syncope (n=21). Notably, physical examination had high specificity for major cardiac abnormalities (valvular lesion or pericardial effusion ≥ moderate or systolic dysfunction greater than mild) but markedly low sensitivities which were dramatically improved by addition of a FoCUS study.
Conclusions: Careful history and physical examination remains the cornerstone of patient evaluation. Routine addition of a FoCUS study increases the likelihood of an accurate diagnosis and detection of major cardiac abnormalities at point of care.
Author Disclosures: B. Hibbert: None. T. Simard: None. F. Ramirez: None. P. Di Santo: None. C. Johnson: None. M. Turek: None. M. Labinaz: None. B. Chow: None. M.R. Le May: None.
- © 2016 by American Heart Association, Inc.