Direct Access to Echocardiography in line with New Zealand Regional Minimum Standards Leads to Early Detection and Treatment of Valvular Pathology. We Provided Quantitative Data to Facilitate Planning of Similar Care Pathways

Direct access to echocardiograms by general practitioners for murmur assessment in adult populations is variably available across New Zealand. There is a paucity of published data on detection rates for pathology and for knock-on effects for clinical services. This audit examines outcomes of GP-referred echocardiograms for murmur assessment in the Nelson-Marlborough region. Access was determined by Central Region minimum standards for referral and access to secondary cardiac care. Detection rates for valvular pathology were audited over a two-year period with subsequent care pathway decisions. In a population of 136,995 residents, 252 echocardiograms were performed. Pathology was found in 133 patients (53%). 75 patients had aortic stenosis, 78 had mitral regurgitation, and 49 had aortic regurgitation. 39% with normal aortic valves had turbulent flow murmurs. 62 patients entered a technician-led valve follow-up service, 25 required a formal first specialist assessment (FSA), and 26 patients required 44 further investigations, leading to nine surgical interventions. When standardised to a 100,000 patient rate, Nelson-Marlborough could expect to generate 45 valve follow-up scans, 18 FSA appointments, 32 further investigations and seven patients referred for surgery over two years. A direct access pathway to echocardiography if appropriately utilised in line with Central Region minimum standards for access to care leads to early detection and treatment of valvular pathology. This data provides valuable information for clinical services wishing to provide such access. It quantifies detection rates by auscultation for valvulopathies and subsequent effects for clinical services, including expected numbers of further investigations, FSA appointments and valvular operations.