Mind the gap: missed valve disease diagnosis

Otto, Catherine M

doi:10.1136/heartjnl-2018-313474

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…Editor-in-chief of the international journal Heart, Catherine Otto, says’“it’s time to turn to more effective technology—ultrasound, not acoustic sound’ in an editorial from 2018. 26 She commented on the study by Gardezi et al , the study in this review with the lowest diagnostic accuracy. She argues that one should start to teach POCUS to healthcare providers, instead of focusing on training in the nuances of heart sounds heard with the stethoscope.…”

Section: Discussionmentioning

confidence: 95%

Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review

et al. 2023

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ObjectiveThe objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors.Design/methodsA systematic literature search for diagnostic studies comparing heart auscultation to echocardiography or angiography, to evaluate VHD in adults, was performed in MEDLINE (1947–November 2021) and EMBASE (1947–November 2021). Two reviewers screened all references by title and abstract, to select studies to be included. Disagreements were resolved by consensus meetings. Reference lists of included studies were also screened. The results are presented as a narrative synthesis, and risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2.Main outcome measuresSensitivity, specificity and likelihood ratios (LRs).ResultsWe found 23 articles meeting the inclusion criteria. Auscultation was compared with full echocardiography in 15 of the articles; pulsed Doppler was used as reference standard in 2 articles, while aortography and ventriculography was used in 5 articles. One article used point-of-care ultrasound. The articles were published from year 1967 to 2021. Sensitivity of auscultation ranged from 30% to 100%, and specificity ranged from 28% to 100%. LRs ranged from 1.35 to 26. Most of the included studies used cardiologists or internal medicine residents or specialists as auscultators, whereas two used general practitioners and two studied several different auscultators.ConclusionSensitivity, specificity and LRs of auscultation varied considerably across the different studies. There is a sparsity of data from general practice, where auscultation of the heart is usually one of the main methods for detecting VHD. Based on this review, the diagnostic utility of auscultation is unclear and medical doctors should not rely too much on auscultation alone. More research is needed on how auscultation, together with other clinical findings and history, can be used to distinguish patients with VHD.PROSPERO registration numberCRD42018091675.

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Section: Discussionmentioning

confidence: 95%

Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review

et al. 2023

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“…We estimate that a sample size of 580 would be necessary to investigate equivalence between scientist and cardiologist with 80% power and assuming an acceptable difference in performance of <5%. By contrast, the point-of-care scan had a sensitivity of 100% when performed by either scientist or cardiologist showing its superiority over auscultation for the detection of valve disease 8. We believe that auscultation should still be included in the assessment at a murmur clinic since a number of uncommon abnormalities (eg, muscular ventricular septal defect, aortic coarctation or pulmonary stenosis) would usually be associated with obvious systolic murmurs but might not be detected by a point-of-care scan.…”

Section: Discussionmentioning

confidence: 98%

“…Furthermore, standard echocardiograms (transthoracic echocardiogram (TTE)) take about 45 min to perform and are a relatively scarce resource. It has been suggested that a more limited ‘point-of-care scan’ taking 10–15 min can screen out patients not requiring TTE 8 9. This has not previously been investigated.…”

Section: Introductionmentioning

confidence: 99%

Murmur clinic: validation of a new model for detecting heart valve disease

Draper

Subbiah

Bailey

et al. 2018

Heart

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“…A recent study found the presence of an audible murmur to have limited accuracy for the detection of VHD [ 25 ], suggesting that easy access to echocardiography for patients with symptoms is a better diagnostic strategy. Echocardiography has been touted as the natural next step in heart diagnostics in primary care, and comprehensive training in point of care ultrasound has been recommended [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Interrater and intrarater agreement on heart murmurs

Andersen

Davidsen

Schirmer

et al. 2022

Scandinavian Journal of Primary Health Care

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Objective To investigate interrater and intrarater agreement between physicians and medical students on heart sound classification from audio recordings, and factors predicting agreement with a reference classification. Design Intra- and interrater agreement study. Subjects Seventeen GPs and eight cardiologists from Norway and the Netherlands, eight medical students from Norway. Main outcome measures Proportion of agreement and kappa coefficients for intrarater agreement and agreement with a reference classification. Results The proportion of intrarater agreement on the presence of any murmur was 83% on average, with a median kappa of 0.64 (range k = 0.09–0.86) for all raters, and 0.65, 0.69, and 0.61 for GPs, cardiologist, and medical students, respectively. The proportion of agreement with the reference on any murmur was 81% on average, with a median kappa of 0.67 (range 0.29–0.90) for all raters, and 0.65, 0.69, and 0.51 for GPs, cardiologists, and medical students, respectively. Distinct murmur, more than five years of clinical practice, and cardiology specialty were most strongly associated with the agreement, with ORs of 2.41 (95% CI 1.63–3.58), 2.19 (1.58–3.04), and 2.53 (1.46–4.41), respectively. Conclusion We observed fair but variable agreement with a reference on heart murmurs, and physician experience and specialty, as well as murmur intensity, were the factors most strongly associated with agreement. Key points: Heart auscultation is the main physical examination of the heart, but we lack knowledge of inter- and intrarater agreement on heart sounds. • Physicians identified heart murmurs from heart sound recordings fairly reliably compared with a reference classification, and with fair intrarater agreement. • Both intrarater agreement and agreement with the reference showed considerable variation between doctors • Murmur intensity, more than five years in clinical practice, and cardiology specialty were most strongly linked to agreement with the reference.

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Mind the gap: missed valve disease diagnosis

Cited by 7 publications

References 8 publications

Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review

Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review

Murmur clinic: validation of a new model for detecting heart valve disease

Interrater and intrarater agreement on heart murmurs

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