The Dutch experience of open access echocardiography

Cardiac disease is not easy to recognise in general practice. An echocardiogram is an excellent way to provide information about left ventricular mass and diastolic (dys)function and the presence of valvular heart disease. To improve diagnostic care of cardiac patients, an open access echocardiography service was established in the referral area of our hospital, where general practitioners were able to ask for an echocardiogram without referring the patient to the cardiologist. Between December 2002 and October 2006 echocardiograms were requested for 471 patients. Thirteen percent of the patients referred for dyspnoea and 3% of patients with a cardiac murmur had a left ventricular ejection fraction <40%. In 28% of patients no cardiac abnormality could be found. If we looked at the prevalence of hypertension in the referred patients, this was very high with a prevalence of up to 60% in the older age groups. If we included hypertension in the analysis, only 16% of patients had no structural cardiac or vascular abnormality. The study shows that the advantage of open access echocardiography in the Netherlands is that the general practitioner is able to make a better diagnosis and unnecessary referrals of patients with suspected cardiac disease can be avoided.