Open access echocardiography A primary care view

1. Open access echocardiographyA primary care view Dr Amrit Takhar General Practitioner Wansford surgery

2. A primary care view • Practice based Audit of heart failure patients • Changes 1996-8 • Case histories

3. Audit Method • January 1996 Computer search of all patients having prescriptions for diuretics • Records examined for coding of major diagnoses including heart failure and hypertension

4. 1996 Audit criteria • Use of ECG CXR and ECHO at diagnosis • BP, FBC U/E in past 13 months • Whether patients on diuretics for HF were also on an ACE inhibitor

5. 1996 Results

6. Changes since 1996 • Interpretative ECG used routinely in all suspected cases • Open access ECHO - launched Spring 1997 allowing improved investigation facilities • Greater confidence in appropriate use of ACE inhibitors

7. 1998 Audit criteria • Use of ECG and ECHO at diagnosis • Whether patients on diuretics for HF were also on an ACE inhibitor • New cases since Jan 1997

8. 1998 audit Results 15 new cases at Wansford 1997-8:

9. Case 1 71 year old man Longstanding severe COAD / Asthma April 97 episode of severe chest pain - attended 3 weeks later ECG showed signs inferior MI July 97 Exercise ECG limited by SOB

10. Case 1 Standard chest X-ray The heart is not enlarged CTR 15 to 34.5. The lung fields are a little hyperexpanded but no focal lung lesion is seen. The appearance is consistent with COAD Sept 97 C/0 SOB, bubbling sensation in chest. Scattered rhonchi

11. Case 1 Nov 1997 Echocardiogram abnormal Mild to mod left ventricular impairment, Rx Frusemide and lisinopril Symptoms improved

12. Case 2 (1994) 64 year old lady with soboe, worse in mornings, occ tightness in chest, ankle swelling FH Pulse 80 SR, Bilateral basal creps ECG CXR Cholesterol 6.1 Rx Bendrofluazide

13. Case 2 • 1997 Referred for ECHO • Normal echocardiogram • Diuretic stopped • No recurrence of SOB, tendency to URTI