American society of echocardiography: Remote echocardiography with web-based assessments for referrals at a distance (ASE-REWARD) study

Shanemeet Singh, Manish Bansal, Puneet Maheshwari, David Adams, Shantanu P. Sengupta, Rhonda Price, Leaanne Dantin, Mark Smith, Ravi R. Kasliwal, Patricia Pellikka, James D. Thomas, Jagat Narula, Partho P. Sengupta

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: Developing countries face the dual burden of high rates of cardiovascular disease and barriers in accessing diagnostic and referral programs. The aim of this study was to test the feasibility of performing focused echocardiographic studies with long-distance Web-based assessments of recorded images for facilitating care of patients with cardiovascular disease. Methods: Subjects were recruited using newspaper advertisements and were prescreened by paramedical workers during a community event in rural north India. Focused echocardiographic studies were performed by nine sonographers using pocket-sized or handheld devices; the scans were uploaded on a Web-based viewing system for remote worldwide interpretation by 75 physicians. Results: A total of 1,023 studies were interpreted at a median time of 11:44 hours. Of the 1,021 interpretable scans, 207 (20.3%) had minor and 170 (16.7%) had major abnormalities. Left ventricular systolic dysfunction was the most frequent major abnormality (45.9%), followed by valvular (32.9%) and congenital (13.5%) defects. There was excellent agreement in assessing valvular lesions (κ = 0.85), whereas the on-site readings were frequently modified by expert reviewers for left ventricular function and hypertrophy (κ = 0.40 and 0.29, respectively). Six-month telephone follow-up in 71 subjects (41%) with major abnormalities revealed that 57 (80.3%) had improvement in symptoms, 11 (15.5%) experienced worsening symptoms, and three died. Conclusions: This study demonstrates the feasibility of performing sonographer-driven focused echocardiographic studies for identifying the burden of structural heart disease in a community. Remote assessment of echocardiograms using a cloud-computing environment may be helpful in expediting care in remote areas.

Original languageEnglish (US)
Pages (from-to)221-233
Number of pages13
JournalJournal of the American Society of Echocardiography
Volume26
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Echocardiography
Cardiovascular Diseases
Referral and Consultation
Newspapers
Feasibility Studies
Left Ventricular Dysfunction
Left Ventricular Hypertrophy
Left Ventricular Function
Telephone
Developing Countries
Reading
India
Heart Diseases
Patient Care
Physicians
Equipment and Supplies
Cloud Computing

Keywords

  • Community outreach
  • Echocardiography
  • Portable ultrasound
  • Telemedicine

ASJC Scopus subject areas

  • Medicine(all)
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

American society of echocardiography : Remote echocardiography with web-based assessments for referrals at a distance (ASE-REWARD) study. / Singh, Shanemeet; Bansal, Manish; Maheshwari, Puneet; Adams, David; Sengupta, Shantanu P.; Price, Rhonda; Dantin, Leaanne; Smith, Mark; Kasliwal, Ravi R.; Pellikka, Patricia; Thomas, James D.; Narula, Jagat; Sengupta, Partho P.

In: Journal of the American Society of Echocardiography, Vol. 26, No. 3, 03.2013, p. 221-233.

Research output: Contribution to journalArticle

Singh, S, Bansal, M, Maheshwari, P, Adams, D, Sengupta, SP, Price, R, Dantin, L, Smith, M, Kasliwal, RR, Pellikka, P, Thomas, JD, Narula, J & Sengupta, PP 2013, 'American society of echocardiography: Remote echocardiography with web-based assessments for referrals at a distance (ASE-REWARD) study', Journal of the American Society of Echocardiography, vol. 26, no. 3, pp. 221-233. https://doi.org/10.1016/j.echo.2012.12.012
Singh, Shanemeet ; Bansal, Manish ; Maheshwari, Puneet ; Adams, David ; Sengupta, Shantanu P. ; Price, Rhonda ; Dantin, Leaanne ; Smith, Mark ; Kasliwal, Ravi R. ; Pellikka, Patricia ; Thomas, James D. ; Narula, Jagat ; Sengupta, Partho P. / American society of echocardiography : Remote echocardiography with web-based assessments for referrals at a distance (ASE-REWARD) study. In: Journal of the American Society of Echocardiography. 2013 ; Vol. 26, No. 3. pp. 221-233.
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abstract = "Background: Developing countries face the dual burden of high rates of cardiovascular disease and barriers in accessing diagnostic and referral programs. The aim of this study was to test the feasibility of performing focused echocardiographic studies with long-distance Web-based assessments of recorded images for facilitating care of patients with cardiovascular disease. Methods: Subjects were recruited using newspaper advertisements and were prescreened by paramedical workers during a community event in rural north India. Focused echocardiographic studies were performed by nine sonographers using pocket-sized or handheld devices; the scans were uploaded on a Web-based viewing system for remote worldwide interpretation by 75 physicians. Results: A total of 1,023 studies were interpreted at a median time of 11:44 hours. Of the 1,021 interpretable scans, 207 (20.3{\%}) had minor and 170 (16.7{\%}) had major abnormalities. Left ventricular systolic dysfunction was the most frequent major abnormality (45.9{\%}), followed by valvular (32.9{\%}) and congenital (13.5{\%}) defects. There was excellent agreement in assessing valvular lesions (κ = 0.85), whereas the on-site readings were frequently modified by expert reviewers for left ventricular function and hypertrophy (κ = 0.40 and 0.29, respectively). Six-month telephone follow-up in 71 subjects (41{\%}) with major abnormalities revealed that 57 (80.3{\%}) had improvement in symptoms, 11 (15.5{\%}) experienced worsening symptoms, and three died. Conclusions: This study demonstrates the feasibility of performing sonographer-driven focused echocardiographic studies for identifying the burden of structural heart disease in a community. Remote assessment of echocardiograms using a cloud-computing environment may be helpful in expediting care in remote areas.",
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