Authors (including presenting author) :
Lai KPL(1), Chan PF(1), Fung HT(1), Wong SN(1), Luk MHM(1), Leung CY(2), Wong CH(2), Ching S(3), Yue CS(3)
Affiliation :
(1) Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
(2) Department of Medicine, Tseung Kwan O Hospital (TKOH)
(3) Department of Medicine & Geriatrics, United Christian Hospital (UCH)
Introduction :
Echocardiography (echo) is essential to the assessment and management of many cardiac diseases. With the ageing population, many patients in primary care developed cardiac diseases that requiring echo assessment. To meet the increasing service demand, transthoracic echocardiography (TTE) service was implemented in KEC GOPCs since December 2023, in collaboration with cardiologists of TKOH and UCH.
Objectives :
(1) To implement TTE service for GOPC patients with predefined cardiac conditions so as to provide timely assessment and reduce referrals to secondary care
(2) To collaborate with cardiologists on clinical support for patients with abnormal echo findings
Methodology :
Echo training for family medicine (FM) consultants were provided by cardiologists in TKOH and UCH in 2023. Clinical guidelines on echo examination and interpretations were prepared. Direct consultation by cardiologists through instant messaging app platform was established. Fast track referral for abnormal echo findings that required cardiologists’ further evaluation would be provided as indicated.
GOPC patients with atrial fibrillation (AF), asymptomatic heart murmur or known significant valvular heart disease (VHD) would be referred to the FM echo sessions.
To evaluate the outcomes of patients with TTE performed in primary care, clinical information of all patients attending the echo sessions from 1st December 2023 to 30th November 2024 were reviewed.
Result & Outcome :
138 TTE were performed in 133 patients during the review period. Mean age of patients was 75.5 (range 50–96) years old. 50.4% were male patients. 73.7%, 17.3% and 6.0% of patients were referred for AF, VHD and heart murmur respectively.
5.3% and 29.3% of patients were found to have reduced left ventricular ejection fraction and impaired diastolic dysfunction respectively. 28.6% of patients had left ventricular hypertrophy in which 1 patient was diagnosed with hypertrophic cardiomyopathy. 89.5% of patients had various degrees of VHD in which two patients were found to have aortic stenosis, two with mitral stenosis, one with severe mitral regurgitation and five with severe tricuspid regurgitation. Pulmonary hypertension was suspected in 24.1% of patients. 5 patients (3.8%) were found to have pericardial effusion and 4 patients (3.0%) were suspected with atrial or ventricular septal defects.
18.0% and 11.3% of patients were arranged with follow-up echo in hospital and referred to Cardiac Clinic for further assessment respectively.
Conclusion:
In collaboration with cardiologists, family physicians could provide timely echo assessment for patients with predefined cardiac conditions in primary care and reduce the workload in secondary care.
