LONDON – Cardiologists’ auscultation skills in the detection of valvular murmurs are “alarmingly low,” Dr. Michael J. Barrett reported at the annual congress of the European Society of Cardiology.
He formally tested the auscultation abilities of 1,098 cardiologists attending meetings of the American College of Cardiology. The results proved disheartening: The cardiologists, all voluntary participants in the project, were able to identify on average only 48% of the basic murmurs, which included aortic stenosis, aortic regurgitation, and mitral stenosis or regurgitation.
They did somewhat better in identifying the advanced murmurs, including mitral valve prolapse, bicuspid aortic valve, combined aortic stenosis and regurgitation, or combined mitral stenosis and regurgitation. But they still got only 66% of those murmurs right, according to Dr. Barrett, a cardiologist at Lehigh Valley Health Network, Allentown, Pa.
Their low success rates were quite similar to the scores achieved by primary care physicians in other studies, even though cardiologists are the ones who are supposed to be the experts in matters of the heart.
All is not lost, however. The participating cardiologists then underwent an intensive 90-minute auscultation training program in which they listened carefully to 400 repetitions of each murmur while viewing visual memory aids, including murmur phonocardiograms. Psychoacoustic research has shown that it takes this sort of dedicated repetition to master new sounds, he explained.
Upon retesting in which the murmurs were presented in random order so as to avoid test/retest score inflation, the cardiologists’ performance improved dramatically. Identification rates of the basic murmurs jumped from 48% to 88%, while scores for advanced murmurs zipped up to 93% from the pretest average of 66%.
Other studies carried out by Dr. Barrett have shown that the improvement in auscultation skills achieved through the learning program is durable.
Accurate auscultation is key to the cost-effective and timely detection of valve disorders, which is more important than ever now that dramatically effective transcatheter therapies are available for diseased aortic and mitral valves, the cardiologist observed.
Dr. Barrett is editor-in-chief of Heart Songs, the downloadable American College of Cardiology auscultation skills improvement program used in the study.