Effect of point-of-care echocardiography by noncardiologists on patient management in acute chest pain

As point-of-care echocardiography (POCE) has expanded beyond cardiology into general emergency medical practice, there has been a lack of standardized, evidence-based imaging protocols and training, thus leading to challenges with respect to the quality of cardiac imaging for acute cardiovascular syndromes. The ENDEMIC study aims to assess the effectiveness of POCE based on structured training for noncardiologists on the management of patients with acute chest pain in emergency departments. A total of 150 patients presenting with acute chest pain possibly of cardiovascular aetiology were enrolled in this prospective randomized clinical trial. Patients were assigned to either the POCE-assisted management group or the standard management group. Physicians performing POCE examinations received focused training based on the British Society of Echocardiography level 1 standard. The primary outcome was the length of stay in the emergency department (ED), and the secondary outcomes included the time to decision, the time to coronary angiography and diagnostic accuracy of the initial examination. Quality of acquired images was also evaluated. The results revealed that the POCE group had a significantly shorter length of ED stay (209.0 vs. 271.0 min, median difference 64 (31–97) min., p = 0.0003), time to decision (138.0 vs. 252.0 min, p < 0.0001) and time to coronary angiography (29.6 vs. 120.3 h, p = 0.027) than the control group. Furthermore, the error of initial diagnoses was lower in the POCE group (6.3% vs. 30.4%, RR = 0.21 [0.047–0.90]). The implementation of POCE by trained noncardiologists significantly reduced the duration of ED stay and enhanced the management of patients with acute chest pain in the ED. Systematic training enables physicians without prior echocardiography experience to perform POCE accurately and efficiently. Preregistered number of clinical trial: NCT05306730 registered 2022-04-01.