Deployment of Point-of-Care Echocardiography to Improve Cardiac Diagnostic Access Among American Indians

• Published in: Journal of the American Heart Association Vol. 13; no. 2; p. e031231
• Main Authors: de Loizaga, Sarah, Benashley, LeCario, Hoekzema, Jacob, Ahmed, Nahreen, Alexander, Craig, Bolger, Ann, Evers, Patrick D, Hill, Garick D, Nakagaayi, Doreen, Nashio, J T, Nunes, Maria Carmo Pereira, Sable, Craig, Tacuri, Luz Marina, Danforth, Kristen, Beaton, Andrea, Close, Ryan
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 16.01.2024; Wiley
• Subjects: American Indian; American Indian or Alaska Native; Echocardiography; health care access; Health Services Accessibility; heart disease; Heart Diseases - diagnostic imaging; Heart Diseases - therapy; Humans; JAHA Spotlight: The AHA Strategically Focused Research Network on Health Technologies and Innovation; Original Research; Point-of-Care Systems; American Indian; heart disease; health care access; echocardiography
• DOI: 10.1161/JAHA.123.031231
• ISSN: 2047-9980

American Indians face significant barriers to diagnosis and management of cardiovascular disease. We sought to develop a real-world implementation model for improving access to echocardiography within the Indian Health Service, the American Indian Structural Heart Disease Partnership. The American Indian Structural Heart Disease Partnership was implemented and evaluated via a 4-step process of characterizing the system where it would be instituted, building point-of-care echocardiography capacity, deploying active case finding for structural heart disease, and evaluating the approach from the perspective of the clinician and patient. Data were collected and analyzed using a parallel convergent mixed methods approach. Twelve health care providers successfully completed training in point-of-care echocardiography. While there was perceived usefulness of echocardiography, providers found it difficult to integrate screening point-of-care echocardiography into their workday given competing demands. By the end of 12 months, 6 providers continued to actively utilize point-of-care echocardiography. Patients who participated in the study felt it was an acceptable and effective approach. They also identified access to transportation as a notable challenge to accessing echocardiograms. Over the 12-month period, a total of 639 patients were screened, of which 36 (5.6%) had a new clinically significant abnormal finding. The American Indian Structural Heart Disease Partnership model exhibited several promising strategies to improve access to screening echocardiography for American Indian populations. However, competing priorities for Indian Health Service providers' time limited the amount of integration of screening echocardiography into outpatient practice. Future endeavors should explore community-based solutions to develop a more sustainable model with greater impact on case detection, disease management, and improved outcomes.