# Diagnostic accuracy and cost-effectiveness of a handheld ultrasound device for cardiac evaluation in noncardiology settings

## TL;DR

Handheld ultrasound devices can accurately and cost-effectively evaluate heart conditions at the bedside in noncardiology hospital settings.

## Contribution

Demonstrates the diagnostic accuracy and cost-effectiveness of using handheld ultrasound devices for cardiac evaluation in noncardiology inpatient settings.

## Key findings

- The handheld ultrasound device successfully answered the clinical question in 85% of patients.
- There was excellent agreement between the handheld device and standard echocardiography for most cardiac parameters.
- The HUD-first approach reduced echo-related costs by 74%.

## Abstract

Inpatients frequently require echo evaluation during consultation rounds in noncardiology departments; however, routine standard echocardiography (SE) requires transport to echo lab. We evaluated the diagnostic accuracy and cost-effectiveness of a handheld ultrasound device (HUD) for cardiac evaluation during consultation sessions in noncardiology settings.

The study comprised 139 patients (mean age 68 ± 17 years, 52% male) referred for SE after cardiology consultation in noncardiology departments. Before transport to echo lab, all patients were scanned with the HUD by the consulting cardiologist, and it was noted whether the clinical question was answered. The following parameters were assessed: left ventricular (LV) and right ventricular (RV) size and function, significant valvular heart disease (VHD), pericardial effusion, and inferior vena cava (IVC) size and collapse. A cost-minimization analysis was conducted to compare the cost of SE referral vs. HUD-first strategy from the hospital’s perspective. In 118 (85%) patients, it was possible to successfully answer the clinical question using the HUD. There was excellent agreement for the detection of abnormal LV size and function (k = 0.964), abnormal RV size and function (k = 0.943), pericardial effusion (k = 0.953), and abnormal IVC size and collapse (k = 0.941). There was good agreement for the detection of significant VHD (k = 0.706). The HUD-first approach led to 74% reduction in echo-related costs.

This study demonstrates that HUDs could be used by experts as a cost-saving, first-line approach for cardiac evaluation in noncardiology inpatient settings, with high diagnostic accuracy. These findings support the selective adoption of a HUD-first strategy in consultative cardiology practice, when examinations are performed by trained cardiologists and integrated within a structured diagnostic pathway.

Many patients who are hospitalized for conditions unrelated to heart disease still require evaluation by a heart specialist. Traditionally, this process involves performing a comprehensive heart ultrasound test. However, these tests often take significant time, require moving patients to different areas within the hospital, increase length of stay, and can be expensive. As a result, healthcare providers are actively seeking quicker and simpler methods to assess heart health directly at the bedside.

This study explored an alternative approach utilizing a compact, handheld ultrasound device with advanced capabilities. With this technology, a heart specialist can conduct an ultrasound examination immediately during a patient consultation, right at the bedside. The research compared the effectiveness of this rapid bedside exam with the standard, comprehensive heart ultrasound, focusing on how well each approach could address the most critical clinical questions.

The results showed that the handheld ultrasound exam provided doctors with the necessary information in most cases. Specifically, it was highly accurate in evaluating heart pumping function, detecting fluid around the heart, and volume status. For numerous heart conditions, the findings from the handheld device closely matched those from the full cardiac ultrasound test. Introducing this device as the initial step in evaluation also led to a reduction in the number of comprehensive ultrasound tests required, resulting in significant cost savings and more efficient patient care, since the clinical question could be answered at the bedside.

Overall, the study demonstrates that modern handheld ultrasound devices with advanced features can enable healthcare professionals to assess hospitalized patients more rapidly and effectively. This approach has the potential to enhance patient comfort, decrease waiting times, and lower healthcare costs, all while providing doctors with reliable information to support clinical decision making.

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