The use of stethoscopes for heart exams by primary care physicians may one day become a thing of the past, thanks to a Duke study on miniaturized echocardiography machines.
These smaller echo machines were created to provide primary care physicians with a more thorough examination of patients' hearts.
"A regular doctor does not have the proper training, or the money, to have a standard echo machine in the office," said Dr. John Alexander, assistant professor of medicine and cardiology.
Although the machines, which cost $12,000--a fraction of the price of their larger counterparts--cannot replace larger echocardiography machines for complete heart examinations, they can be used to assess basic heart problems less likely to be predicted by a stethoscope and family history exam.
By answering basic questions regarding heart health, these smaller echos also reduce the number of unnecessary tests done on the larger machines. In addition, the miniature echos cut exam-time length from 20 minutes to eight.
"About half of the echo tests we perform in Duke's echo facility are just to answer simple questions," Alexander said. "The smaller echo machines would greatly reduce those types of cases we see."
Although confident that the smaller echo machines would provide better exams, Alexander recently completed a study to determine how much echo test training was required for primary care physicians without cardiology training.
The study trained second-year medical residents and cardiology fellows to diagnose four major heart abnormalities, varying in level of diagnostic difficulty, during a three-hour session.
"We chose three hours for the amount of training because it is impractical to expect physicians to spend a week learning how to use the machines," Alexander said. He added that if doctors could accurately assess the four conditions, they would be able to find the most common heart problems.
Once trained, each doctor performed mini echocardiograms on 25 to 50 patients, all of whom previously had undergone echo tests. The results from the doctors with the mini echo machines were compared to the results of the full echo tests assessed by cardiologists.
Doctors were able to diagnose all four conditions. Alexander said the trainees were better able to assess conditions that are easier to detect, but that overall they proved they could properly use the machines with very little training.
"I felt very comfortable using the machine," said Dr. Cheryl Russo, a cardiology fellow who participated in the study.
First-year cardiology fellow Dr. Dan Bensimhon said the training was "easy and straightforward." He added, "You get so much more from the mini echo tests than from a stethoscope.... The results were amazing."
Both Bensimhon and Russo agreed they would have liked more training and more feedback on their individual performances. "You want more time because you always want to be better at what you do," Bensimhon said.
Alexander said that although the three hours of training proved successful, the study was inconclusive about the ideal amount of training. He added that the proper training time is somewhere between three hours and one week.
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