SAN FRANCISCO — Patients with decompensated heart failure were three times more likely than patients without heart failure to have S3 or S4 heart sounds detected by sensors in a study of 135 patients seen in emergency departments, Sean P. Collins, M.D., reported.
The add-on sensor device, which attaches to an ECG machine to analyze heart sounds, may allow quicker diagnosis and treatment of patients with heart failure, Dr. Collins said at the annual meeting of the American College of Emergency Physicians.
The abnormal diastolic heart sounds S3 and S4 indicate elevated ventricular filling pressures and suggest that the heart's ability to squeeze out blood is impaired.
Previous studies have shown that the Audicor sensor system detects more of the hard-to-hear S3 and S4 sounds than can be heard by cardiologists, said Dr. Collins of the University of Cincinnati. Inovise Medical Inc., which makes the Audicor system, funded the current study.
The prospective study of patients with signs and symptoms of decompensated heart failure compared the heart sounds detected by the Audicor system in patients with a primary or secondary diagnosis of heart failure or a non-heart failure diagnosis. The diagnosis was based on the attending physician's discharge summary, not on the Audicor data.
Of 46 patients with a primary diagnosis of heart failure, 19 (41%) had an S3 sound, and 8 (17%) had an S4 sound. Those rates were triple the prevalences seen in 68 patients with non-heart failure diagnoses, 9 (13%) of whom had an S3, and 4 (6%) of whom had an S4. Among 21 patients with a secondary diagnosis of heart failure, 6 (29%) had an S3 and 4 (19%) had an S4, Dr. Collins said. (See table.)
In general, about 80% of people with heart failure come through emergency departments, but 10%-20% are misdiagnosed. To have results from an ECG plus Audicor at the patient's bedside “would allow me to immediately treat them and not wait for other tests to come back” if the printout reports an S3 or S4, he added.
The Food and Drug Administration-approved Audicor system costs approximately $6,000, plus $40 per patient for the leads, Dr. Collins said.
Andy Jagoda, M.D., who moderated the press briefing on the research findings, praised the study and said the Audicor system has “a lot of potential.” With approximately 800,000 patients per year seen in emergency departments for heart failure, anything to improve diagnostic accuracy would be welcomed, said Dr. Jagoda, professor of emergency medicine at Mount Sinai School of Medicine, New York.
Kevin Foley. Research