OPEN ACCESS ECHOCARDIOGRAPHY IN MANAGEMENT OF HEART-FAILURE IN THE COMMUNITY

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 who 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 measure-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.