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

• DOI: 10.1161/circ.132.suppl_3.18811
• Publication Date: 2022-03-19T21:52:40Z
• Authors: Andrea Beaton; Bruno R Nascimento; Adriana C Diamantino; Gabriel T Pereira; Eduardo L Lopes; Cassio O Miri; Kaciane K Bruno; Graziela Chequer; Camila G Ferreira; Luciana C Lafeta; Hedda Richards; Lindsay Perlman; Catherine Webb; Antonio L Ribeiro; Craig Sable; Maria do Carmo P ...
• Keywords: Gold standard (test)

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 non-experts perform RHD promising; however, investigations into workforce composition replicable training schemes needed. Objective: Test non-experts’ ability conduct following a brief, standardized, computer-based course. Methods: Six with variety backgrounds (nurses, health technicians, medical students) echo experience (6 wks-1 yr) completed 3-module curriculum focusing on simplified criteria (mitral regurgitation (MR) ≥1.5cm and/or any aortic regurgitation). Following training, two teams 3 were placed school environments. Gold-standard diagnoses (2012, World Heart Federation criteria) made by cardiologists using standard portable equipment. Children diagnosed 25% general population was blindly evaluated each non-expert handheld echo. Results: Screening performed 1,381 children, 397 (47 borderline RHD, 6 definite 336 normal & 8 other) referred (209 Team 1 188 2). Age ranged from 5-18 years (mean 13.6); 59% female. Overall sensitivity approach 90.8% (95% CI 85.4-94.6%; range 75-100%), an overall specificity 82.4% 79.9-84.7%; 75-89%). The common reasons false-negative screens (n=16) missed MR (44%) ≤1.5cm (29%), false-positive (n=179) included identification erroneous color jets (25%), incorrect measurement (24%), appropriate application guidelines (MR between 1.5 2.0 cm, 39.4%). Conclusions: A short, can be successfully used train heterogeneous group preform large-scale screening. This addresses prohibitive barriers holds potential significantly reduce global burden RHD.