Perspective:

Small portable HHE devices have been in use for approximately a decade. Previous studies have demonstrated a degree of utility when utilized by non-echocardiographers including PCPs, physician extenders, and medical house officers typically when used for targeted purposes such as assessment of LV systolic function, pericardial effusion, and overall volume status. In more remote regions where rheumatic heart disease is prevalent, they have shown utility for screening for occult rheumatic valvular heart disease when utilized by physician extenders. In this study, investigators employed remote expert reading of a limited number of echocardiographic images acquired by PCPs using a handheld device. Agreement was generally good for presence of a normal heart and detection of severe abnormalities, and the majority of studies deemed normal or showing only mild abnormalities did not have severe relevant abnormalities when reviewed by an expert interpreter. This study is unique among others evaluating HHE in that remote expert interpretation of the acquired images was available after which decision making regarding established diagnosis, the need for full-service echocardiography or the appropriateness of patient discharge was reassessed and demonstrated a decrease in more expensive full-service resource utilization. Of note, the accuracy of the PCP for detecting abnormalities and the agreement between experts and PCPs did not significantly increase over the time course of this study, suggesting that intrinsic limitations in the HHE imaging platforms may result in a plateau of clinical efficacy when used by non-echocardiographers.