Adoption of point-of-care cardiac ultrasound on the rise

Point-of-care cardiac ultrasound, now available in units as small as a smartphone, is being adopted by medical students and noncardiologists and, eventually, could replace the stethoscope, according to a series of reports published in Global Heart.

“Ultrasound is fast becoming an imaging modality that is rapidly and quickly employed in many … time-limited and imaging-sensitive scenarios,” J. Christian Fox, MD, of the University of California, Irvine, and colleagues wrote in one report.

Useful applications

Among the useful applications for point-of-care ultrasound are evaluation of chest pain, shock and dyspnea, according to Fox and colleagues.

A patient presenting with chest pain may have to wait as long as 24 hours for a traditional detailed cardiac workup for ACS, but “using ultrasonography, some of the most time-dependent decisions have been shown to reduce morbidity and mortality,” they wrote.

With shock, it is critical to find out the underlying condition quickly, and for that, “ultrasound is more accurate, more cost-effective, and less invasive than any other diagnostic measurements,” Fox and colleagues wrote.

Diagnosis of the underlying cause of dyspnea has traditionally been confounding, but “the use of ultrasonography has been useful in delineating a difference between pulmonary and cardiac contributory pathologies,” they wrote.

Point-of-care ultrasound “has the potential to become ‘the stethoscope of the 21st century’” because it is “effective, safe and portable, and it happens in real time,” Fox and colleagues wrote. “Not only is ultrasound more comprehensive and accurate than physical examination, but it also helps with earlier detection of potentially life-threatening conditions, such as cardiac tamponade, and confirmation of pulseless electrical activity.”

Because of these factors, many medical schools have integrated ultrasonography into their curricula. According to Fox and colleagues, it also makes sense to begin training on this use of point-of-care ultrasound during medical school because “the level of proficiency required to expertly pilot this device supports a model for ultrasound education earlier within a physician’s medical career.”

Several studies have demonstrated benefits of this approach. In one study, “not only were students capable of capturing images of cardiac pathology on patients, but their diagnostic skills were far superior in detecting valvular disease, left ventricular hypertrophy, and cardiac dysfunction than those of trained cardiologists performing physical examinations,” the authors wrote.

Adoption by other specialties

Point-of-care cardiac ultrasound also is being adopted by noncardiologists, particularly those in emergency medicine, critical care, hospital wards and out-of-hospital environments, Bret P. Nelson, MD, and Amy Sanghvi, MD, both of the Icahn School of Medicine at Mount Sinai, New York City, wrote in another report.

“Focused cardiac ultrasound, performed in real time by treating clinicians, has the advantage of being inexpensive, repeatable, and intimately tied to the overall clinical picture of the patient,” they wrote. “As our health care system becomes increasingly interested in cost-effective and evidence-based care, we are likely to see clinician-performed focused examinations complemented by comprehensive specialist studies with clear clinical indications.”

Numerous studies have shown the prognostic value of emergency physician-performed cardiac ultrasound, including one in which emergency physicians demonstrated pericardial effusion with a sensitivity of 96% and a specificity of 98%, Nelson and Sanghvi wrote.

Other studies have shown the efficacy of pocket-sized ultrasounds in the ICU. In one such study, adequate images were obtained 97% of the time, the ultrasound imparted new information 37.3% of the time, and the devices helped medical decision-making approximately one-quarter of the time, according to the report.

Jagat Narula

In a related editorial, Nelson and Jagat Narula, MD, said portable ultrasound is “being used in areas without easy access to imaging of any kind” because of lower costs and less upkeep. It is being used to screen for cardiac conditions, infectious disease symptoms and other conditions. Narula, also of the Icahn School of Medicine, is editor-in-chief of Global Heart and a member of the Cardiology Today Editorial Board.

For more information:

Fox JC. Global Heart. 2014;8:289-292.

Nelson BP. Global Heart. 2014;8:293-297.

Nelson BP. Global Heart. 2014;8:287-288.

Disclosure: The authors of all three papers report no relevant financial disclosures.