Echocardiographic screening for cardiovascular disease in central South Africa: expanding the role of echocardiography in patient referral

E van den Heever, L Botes, SC Brown, FE Smit

Abstract

Introduction: Cardiovascular disease affects millions of people, resulting in significant rates of morbidity and mortality. Inadequate healthcare systems, combined with costly treatments, impose a high economic burden, with growing challenges in the public healthcare arena. The demand for equitable access to specialised services is high in a country where most of the population relies on public healthcare services.
Aim: This study investigated the shortcomings and possible solutions to expedite referral for appropriate diagnosis and therapy.
Results: In a sub-analysis performed on 2 523 first-time echocardiography referrals to a tertiary-care hospital, cardiac abnormalities were diagnosed in 74% of patients. Most significant were valvular disorders (33%) and secondary pulmonary hypertension (19%). More than a third of patients presented with severe valvular disease, indicative of progressive heart disease and late referral. Almost a half (44%) of patients with cardiomyopathy presented with severely impaired left ventricular systolic function at first referral (left ventricular ejection fraction <30%), suggesting missed diagnosis and/or late referral.
Conclusion: The study demonstrated a high demand for echocardiographic services from secondary regional and district hospitals in central South Africa. Late referrals can be attributed to long travelling distances and the number of regional hospitals. The availability of echocardiographic screening could fill the void in the current healthcare system to expedite diagnosis and effective referral.