Feasibility of point-of-care cardiac ultrasound performed by clinicians at health centers in Tanzania

Abstract

Background Point-of-care cardiac ultrasound (cardiac POCUS) has potential to become a useful tool for improving cardiovascular care in Tanzania. We conducted a pilot program to train clinicians at peripheral health centers to obtain and interpret focused cardiac POCUS examinations using a hand-held portable device. Methods Over a 5-day period, didactic and experiential methods were used to train clinicians to conduct a pre-specified scanning protocol and recognize key pathologies. Pre- and post-training knowledge and post-training image acquisition competency were assessed. In their usual clinical practices, trainees then scanned patients with cardiovascular signs/symptoms, recorded a pre-specified set of images for each scan, and documented their interpretation as to presence or absence of key pathologies on a case report form. A cardiologist subsequently reviewed all images, graded them for image quality, and then documented their interpretation of key pathologies in a blinded fashion; the cardiologist interpretation was considered the gold standard. Results 8 trainees (6 Clinical Officers, 1 Assistant Medical Officer, and 1 Medical Doctor) initiated and completed the training. Trainees subsequently performed a total of 429 cardiac POCUS examinations in their clinical practices over a 9 week period. Stratified by trainee, the median percent of images that were of sufficient quality to be interpretable was 76.7% (range 18.0–94.2%). For five of eight trainees, 75% or more of images were interpretable. For detection of pre-specified key pathologies, kappa statistics for agreement between trainee and cardiologist ranged from − 0.03 (no agreement) for detection of pericardial effusion to 0.42 (moderate agreement) for detection of tricuspid valve regurgitation. Mean kappa values across the key pathologies varied by trainee from 0 (no agreement) to 0.32 (fair agreement). Conclusions The 5-day training program was sufficient to train most clinicians to obtain basic cardiac images but not to accurately interpret them. Proficiency in image interpretation may require a more intensive training program.

Point-of-care ultrasound for tuberculosis management in Sub-Saharan Africa—a balanced SWOT analysis

“…While complete echocardiography remains firmly in the domain of experts, (Kimambo et al 2021) the specific skill of identifying pericardial effusion has high diagnostic accuracy in POCUS-trained physicians, with a sensitivity and specificity of 89-91% and 96% respectively. (Chamsi-Pasha, Sengupta, and Zoghbi 2017)…”

Use of a Handheld Ultrasonographic Device to Identify Heart Failure and Pulmonary Disease in Rural Africa

“… 31 In a study from Tanzania, clinicians were trained in POCUS of the heart during a 5-day training program. 32 Nonexperts in echocardiography were able to screen for rheumatic heart disease using a handheld echocardiography device in Sudan, 33 and POCUS findings with a handheld device were found to be reliable in detecting urgent obstetric conditions. 34 In all of these reports, the generated images were deemed appropriate by the expert reviewers of the images, with substantial agreement.…”

“…Training in POCUS for assessing pediatric respiratory diseases was successfully conducted in a center in South Sudan . In a study from Tanzania, clinicians were trained in POCUS of the heart during a 5-day training program . Nonexperts in echocardiography were able to screen for rheumatic heart disease using a handheld echocardiography device in Sudan, and POCUS findings with a handheld device were found to be reliable in detecting urgent obstetric conditions .…”

Heart failure diagnosis in the general community – Who, how and when? A clinical consensus statement of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

“…Point-of-care ultrasound represents an important tool in the move of echocardiography away from large hospital-based cart machines to hand-held portable machines able to be used in the community clinic and in resource-limited settings. [86][87][88] The analysis and interpretation of these scans can be achieved using telehealth models or artificial intelligence assisted automated reporting tools. Such tools have been demonstrated to have similar accuracy to expert sonographer measurements and have the potential to increase access to echocardiography, reduce costs and increase throughput in heart failure screening and diagnosis.…”

“…With a growing elderly population along with an increasing burden of risk factors associated with heart failure such as diabetes, obesity and AF, the incidence of heart failure is expected to rise in the coming years, therefore new strategies to facilitate access to diagnostic echocardiography and its time‐consuming analysis are urgently required. Point‐of‐care ultrasound represents an important tool in the move of echocardiography away from large hospital‐based cart machines to hand‐held portable machines able to be used in the community clinic and in resource‐limited settings 86–88 . The analysis and interpretation of these scans can be achieved using telehealth models or artificial intelligence assisted automated reporting tools.…”