Cardiologists Fail to Identify Basic Heart Murmurs

Cardiologists failed to identify more than half of basic and about 35% of advanced prerecorded heart murmurs, according to a new study.

Researchers at Brigham and Women's Hospital (Boston, MA, USA) and Morsani College of Medicine (Tampa, FL, USA) recruited 1,098 cardiologists who agreed to undergo assessment of their auscultation skills. The participants chose to be tested on a set of basic murmurs—aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation; on a set of advanced murmurs—bicuspid aortic valve, mitral valve prolapse, combined aortic stenosis and regurgitation, and combined mitral stenosis and regurgitation; or both.

After a preliminary test without any training, all of the participants listened to 400 repetitions of each murmur while viewing cardiac images (including phonocardiograms) relevant to each type of lesion; training time averaged 90 minutes for each set of murmurs. For the study, the researchers used Heart Songs 3, a computerized training program offered by the American College of Cardiology (ACC) to improve auscultation skills.

Immediately after the training period, there was another test of the murmurs in a randomized order and from different patients than the training samples. The results showed that while during the pre-test, 980 cardiologists scored on average 48% correct on basic murmurs, post-test scores increased to 88%. On the advanced murmurs, 932 cardiologists scored on average 66% correct during pre-test, which improved to 93% on the post-test. The study was presented at the European Society of Cardiology (ESC) annual congress, held during August-September 2015 in London (United Kingdom).

“Recent breakthroughs in the transcatheter treatment of aortic and mitral valve disorders provide new therapies for patients, but physicians must be able to detect valve problems in a timely manner for patients to see the full benefit of these advances,” said lead author Michael Barrett, MD, who also developed Heart Songs 3 for the ACC.

“These findings confirm the widely held view that auscultation skills among cardiologists have eroded over time,” said study coauthor Patrick T. O’Gara, MD, of Brigham and Women's Hospital, past-president of the ACC. “As shown in this and other studies, however, these skills can improve with repetition and training. Accurate auscultation is the first step in the cost-effective evaluation of patients with suspected valvular heart disease.”

Related Links:
Brigham and Women's Hospital
Morsani College of Medicine
Heart Songs 3