MP-2 - A NOVEL MOBILE SCREENING PROGRAM FOR VALVULAR HEART DISEASE

Background: Despite being the next epidemic in cardiovascular disease, valvular heart disease (VHD) has a low public awareness, is underdiagnosed, undertreated, and referred too late in the disease course. A Mobile Screening Program (MSP) has been developed by the University of Ottawa Heart Institute (UOHI) Centre for Valvular Heart Disease (CVHD) to bridge these gaps in care at a primary community level focusing on underserved and indigenous populations, rural communities, and minority groups.

METHODS AND RESULTS: Participants are eligible for the MSP if they are 1) 65 years of age or older, 2) have no known cardiovascular disease, 3) have no follow-up with a cardiologist, and 4) have not undergone an echocardiogram in the preceding 3 years. The MSP uses a point of care ultrasound (POCUS) performed by a specialized sonographer to screen for significant VHD and other significant non-valvular echocardiographic findings. The MSP also has a specialized nurse who screens for the 5 most common cardiovascular risk factors (CV-RF); hypertension, hyperlipidemia, diabetes, smoking, and obesity. Non-fasting cholesterol and HbA1c levels are tested using a finger poke rapid blood test. Recommendations are provided to the participants by the nurse during their appointment based on a predefined algorithm (Figure 1). All results and documentations are reviewed later by a cardiologist specialized in echocardiography. A summary is sent to the primary care provider (PCP) and available to the participant through a secure, online patient portal.

Of the first 300 participants screened, 10% had significant VHD and were referred for a formal transthoracic echocardiogram (TTE) and a consultation with a VHD-specialized cardiologist, 11% were referred to their PCP or walk in clinic for a TTE for significant non-valvular POCUS findings, 2% were referred to the UOHI Rapid Access Clinic for urgent non-valvular POCUS findings, and 33% were referred to their PCP or walk in clinic for above target CV-RF (Figure 2).


Conclusion: A MSP for the detection of VHD using POCUS is feasible. Preliminary results have identified a significant burden of cardiovascular disease with 1/10 participants having significant VHD and 1/10 having significant non-VHD echocardiographic findings. Furthermore, 1/3 of participants have above target CV-RF. The MSP shows promising results for addressing gaps in the healthcare system through facilitating access to care, early detection, and prompt referrals.