# Acceptability of Cardiovascular Disease Point‐of‐Care Diagnostics in Primary Care Settings: A Scoping Review

## TL;DR

This review explores how acceptable cardiovascular disease point-of-care tests are in primary care, especially in low- and middle-income countries, and highlights the need for more strong evidence to support their use.

## Contribution

The study identifies a significant gap in high-quality evidence on the feasibility and clinical utility of CVD point-of-care testing in low- and middle-income countries.

## Key findings

- CVD point-of-care tests are generally acceptable and show potential for clinical use.
- Most studies were observational, with limited randomized controlled trials and evidence from low- and middle-income countries.
- High inter-reviewer agreement and moderate quality scores were found among included studies.

## Abstract

Cardiovascular disease (CVD) remains the leading global cause of death, with 80% of deaths occurring in low‐ and middle‐income countries (LMICs). Improving access to screening and early diagnosis is essential. Point‐of‐care testing (POCT), which provides rapid results near the patient, is particularly valuable in resource‐limited settings. While POCT has been successfully implemented for infectious diseases like HIV and TB, investment in CVD‐focused POCT remains limited. This scoping review maps global evidence on the acceptability of CVD POCT, guided by the World Health Organization's REASSURED criteria, to inform future implementation strategies.

This review followed the Arksey and O'Malley framework. A comprehensive search was conducted across PubMed, Scopus, Science Direct, Google Scholar, Web of Science, and EBSCOhost databases. A preliminary search confirmed feasibility. Two reviewers independently screened studies at all stages, with agreement assessed statistically. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT), version 2018.

Out of 738 articles identified, 13 primary studies conducted in primary care settings were included. Themes emerging from the review included POCT availability, influence on triage and clinical decision‐making, ease of use, sample volume, and feasibility. Only two studies were randomized controlled trials; the rest were observational, mostly comparing POCT accuracy to central laboratory testing. Inter‐reviewer agreement was high (Kappa = 0.92), and MMAT scores ranged from 71.4% to 85.7%.

CVD POCTs are generally acceptable and demonstrate strong potential for clinical integration. However, a lack of robust evidence on patient outcomes, particularly from LMICs, limits the establishment of their effectiveness. More randomized controlled trials and economic evaluations in LMICs, where the burden of CVD is highest, are needed to support broader implementation and inform global strategies to reduce the impact of CVD.

What is known: CVD remains the leading cause of death globally, with limited use of POCT for its management in LMICs despite the success of POCT in infectious diseases.What is new: This scoping review identifies a significant gap in high‐quality evidence on the clinical utility and feasibility of CVD POCT, especially in LMIC primary care settings.What are the clinical implications: Expanding the use of CVD POCT in LMICs could improve early diagnosis and management, but implementation must be guided by robust, context‐specific evidence.

What is known: CVD remains the leading cause of death globally, with limited use of POCT for its management in LMICs despite the success of POCT in infectious diseases.

What is new: This scoping review identifies a significant gap in high‐quality evidence on the clinical utility and feasibility of CVD POCT, especially in LMIC primary care settings.

What are the clinical implications: Expanding the use of CVD POCT in LMICs could improve early diagnosis and management, but implementation must be guided by robust, context‐specific evidence.