Point-of-care ultrasound to assess left ventricular ejection fraction in heart failure in unselected patients in primary care: a systematic review.

ABSTRACT

BACKGROUND: Heart failure (HF) is the most frequent cardiovascular pathology in primary care. Echocardiography is the gold standard for diagnosis, follow-up, and prognosis of HF. Point-of-care ultrasound (POCUS) is of growing interest in daily practice. AIM: This study aimed to systematically review the literature to evaluate left ventricular ejection fraction (LVEF) assessment of unselected patients in primary care by non-expert physicians with cardiac POCUS (cPOCUS). METHODS: We searched in Medline, Embase, and Pubmed up to January 2024 for interventional and non-interventional studies assessing LVEF with cPOCUS in unselected patients with suspected or diagnosed HF in hospital or outpatient settings, performed by non-expert physicians. RESULTS: Forty-two studies were included, involving 6598 patients, of whom 60.2% were outpatients. LVEF was assessed by 351 non-expert physicians after an initial ultrasound training course. The LVEF was mainly assessed by visual estimation (90.2%). The most frequent views were parasternal long/short axis, and apical 4-chamber. The median time of cPOCUS was 8 minutes. A strong agreement was found (κ = 0.72 [0.63; 0.83]) compared to experts when using different types of ultrasound devices (hand-held and standard), and agreement was excellent (κ = 0.84 [0.71; 0.89]) with the same device. Training course combined a median of 4.5 hours for theory and 25 cPOCUS for practice. CONCLUSION: The use of cPOCUS by non-expert physicians after a short training course appears to be an accurate complementary tool for LVEF assessment in daily practice. Its diffusion in primary care could optimize patient management, without replacing specialist assessment.

Heart failure (HF) is the most frequent cardiovascular pathology in primary care. Echocardiography is the gold standard for its diagnosis, follow up and prognosis, especially for assessing left ventricular ejection fraction (LVEF), one of the essential hemodynamic cardiac markers. At a time when access to specialists is difficult, what if primary health care physicians had a tool that enabled them to sort and prioritize patients with suspected or diagnosed HF? Point-of-care ultrasound (POCUS) is already used in daily medical practice to provide optimum bedside diagnostics and tailored medical cares. Thus, we conduct a systematic review up to January 2024, including 42 studies, gathering 6598 patients with suspected or diagnosed HF, with 60% of outpatients. After a brief theoretical and practical training (a median of 4.5 hours and 25 cardiac POCUS), 351 physicians without expertise in cardiac ultrasound (defined as "non-experts") evaluated LVEF in unselected patients with cardiac POCUS, then compared with the experts' assessment. A strong to excellent agreement was found between the two groups, depending on the type of ultrasound device used. The LVEF assessment using cardiac POCUS after a short training course appears to be an accurate complementary tool for non-expert physicians. Its diffusion in primary care could optimize patient management, without replacing specialist assessment.