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Fam Pract. 2010 Aug;27(4):359-62. doi: 10.1093/fampra/cmq019. Epub 2010 Apr 19.

Identification of patients with asymptomatic left ventricular dysfunction: 'real practice' results in primary care.

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  • 1Società Italiana di Medicina Generale (Italian College of General Practitioners), Bisceglie, Italy. d.ambrosio.gaetano@simg.it

Abstract

AIMS:

Asymptomatic systolic left ventricular dysfunction (ASLVD) fulfills the essential criteria to screen for a disease. In Italy, echocardiography screening has been suggested for high-risk patients, albeit not tested in 'real practice'.

OBJECTIVE:

We evaluated the feasibility and the results of such a strategy in primary care.

METHODS AND RESULTS:

Seventy Italian GPs first identified all their 50- to 74-year-old patients with coronary heart disease and/or hypertension and/or diabetes mellitus and/or renal damage, then randomly selected 1405 individuals (one-tenth). In this group, 217 (15%) hypertensive and diabetic patients had no end organ damage evaluation, could not be classified as high/non-high-risk and had no prescription for echocardiogram; 390 individuals [27.7%; 95% confidence interval (CI) 25.4-30%) resulted as high risk. A recent echocardiogram was already available in 129 (33.1%) patients, 122 (31.3%) underwent echocardiography and 139 (35.6%) did not comply with this prescription. Non-compliance and difficult access to echocardiography were the main reasons not to undergo the prescribed echocardiogram. Among the 261 evaluable subjects, 26 (10.8%; 95% CI 7-14.6%) had a <or=50% and 10 (4.0%; 95% CI 1.6-6.4%) a <or=40% left ventricular ejection fraction. Only 5 out of 26 ASLVD cases where detected by echocardiograms performed for pure screening purposes.

CONCLUSION:

Only a third of high-risk patients may benefit from screening, with a modest gain over current practice in terms of new ASLVD diagnoses.

PMID:
20403925
[PubMed - indexed for MEDLINE]
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