Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients

• Published in: Heart (British Cardiac Society) Vol. 104; no. 22; pp. 1832 - 1835
• Main Authors: Gardezi, Syed K M, Myerson, Saul G, Chambers, John, Coffey, Sean, d’Arcy, Joanna, Hobbs, F D Richard, Holt, Jonathan, Kennedy, Andrew, Loudon, Margaret, Prendergast, Anne, Prothero, Anthony, Wilson, Joanna, Prendergast, Bernard D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2018
• Subjects: Accuracy; Aged; Aged, 80 and over; Asymptomatic Diseases; Body mass index; Cardiology; Cardiovascular disease; Echocardiography; England - epidemiology; Family physicians; Female; General Practitioners; Heart; Heart Auscultation; Heart Valve Diseases - diagnosis; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - epidemiology; Heart Valve Diseases - physiopathology; Humans; Internal medicine; Male; Older people; Patients; Physicians; Population; Predictive Value of Tests; Prevalence; Primary care; Primary Health Care; Prospective Studies; Reproducibility of Results; Severity of Illness Index; England; United Kingdom > UK; quality and outcomes of care; health care economics; primary care; valvular heart disease
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2018-313082

ObjectiveCardiac auscultation is a key clinical skill, particularly for the diagnosis of valvular heart disease (VHD). However, its utility has declined due to the widespread availability of echocardiography and diminishing emphasis on the importance of clinical examination. We aim to determine the contemporary accuracy of auscultation for diagnosing VHD in primary care.MethodsCardiac auscultation was undertaken by one of two experienced general practitioners (primary care/family doctors) in a subset of 251 asymptomatic participants aged >65 years undergoing echocardiography within a large community-based screening study of subjects with no known VHD. Investigators were blinded to the echocardiographic findings. Newly detected VHD was classified as mild (mild regurgitation of any valve or aortic sclerosis) or significant (at least moderate regurgitation or mild stenosis of any valve).ResultsNewly identified VHD was common, with mild disease in 170/251 participants (68%) and significant disease in 36/251 (14%). The sensitivity of auscultation was low for the diagnosis of mild VHD (32%) but slightly higher for significant VHD (44%), with specificities of 67% and 69%, respectively. Likelihood ratios were not statistically significant for the diagnosis of either mild or significant VHD in the overall cohort, but showed possible value for auscultation in non-overweight subjects (body mass index <25 kg/m2).ConclusionCardiac auscultation has limited accuracy for the detection of VHD in asymptomatic patients and is a poor diagnostic screening tool in primary care, particularly for overweight subjects. Ensuring easy access to echocardiography in patients with symptoms suggesting VHD is likely to represent a better diagnostic strategy.