Search

Purpose: To evaluate the reasons for disagreement between screening echocardiography (echo), acquired by non-experts, and standard echo in the Brazilian primary care (PC). Methods: Over 20 months, 22 PC workers were trained on simplified handheld (GE VSCAN) echo protocols. Screening groups, consisting of patients aged 17-20, 35-40 and 60-65 years, and patients referred for clinical indications underwent focused echo. Studies were remotely interpreted in US and Brazil, and those diagnosed with major or severe HD were referred for standard echo performed by an expert. Major HD was defined as moderate to severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. A random sample of exams was selected for evaluation of variables accounting for disagreement.Results: A sample of 768 patients was analyzed, 651 (85%) in the referred group. Quality issues were reported in 5.8%, and the random Kappa for major HD between screening and standard echo was 0.51. The most frequent reasons for disagreement were: overestimation of mitral regurgitation (MR) (17.9%, N=138), left ventricular (LV) dysfunction (15.7%, N=121), aortic regurgitation (AR) (15.2%, N=117), LV hypertrophy (13.5%, N=104) and tricuspid regurgitation (12.7%, N=98). Misdiagnosis of mitral and aortic morphological abnormalities was observed in 12.4% and 3.0%, and underestimation of AR and MR occurred in 4.6% and 11.1%. Among 257 patients with suspected mild/moderate MR, 129 were reclassified to normal. Conclusion: Although screening echo with task-shifting in PC is a promising tool in low-income areas, estimation of valve regurgitation and LV function and size account for considerable disagreement with standard exams.

Outra Agência Introdução: A cardiopatia reumática é uma importante causa de morbimortalidade no Brasil. A falta de conhecimento da população sobre a doença limita a eficácia dos programas de prevenção. Este estudo avaliou a efetividade da transmissão de conhecimento resultante de processos educativos sobre cardiopatia reumática em escolas, comparando resultados do método convencional de ensino (aulas expositivas) com o método experimental (worked examples). Material e métodos: Um estudo prospectivo, randomizado por cluster, foi conduzido durante 8 meses em 6 escolas públicas aleatoriamente selecionadas. Cada turma foi considerada um cluster (total 90 turmas), sendo randomizadas de forma 1:1 para receber um dos métodos educacionais. Pré-testes avaliaram o conhecimento dos alunos sobre amigdalites, cardiopatia reumática e febre reumática imediatamente antes do processo educativo. Pós-testes, 10 dias e 3 meses depois, avaliaram a retenção de conhecimento dos alunos. Resultados: Um total de 1.301 alunos (52% do sexo feminino) participou do estudo, sendo 37% do ensino fundamental e 63% do ensino médio. Antes da intervenção, o conhecimento geral foi testado (pré-teste), sendo universalmente baixo (pontuação média aulas expositivas 33,9% x worked examples 32,5%). Uma melhora significante, porém similar, foi observada em ambos os grupos no pós-teste imediato (pré x pós: p