Introduction:Screening echocardiography (echo) may be a tool for early diagnosis and rationalization of referrals in primary care (PC), organizing waiting lines. We aimed to evaluate the role of screening echo integrated with the Brazilian PC for prioritization of referrals and risk stratification.Methods:Over 24 months, 22 healthcare workers at 21 PC centers were trained on simplified handheld (GE VSCAN) echo protocols. Screening (SC) groups, including consented patients aged 17-20, 35-40 and 60-65 years, and patients referred (RF) for clinical indications, in waiting lines, answered a clinical questionnaire and underwent focused echo, interpreted remotely in US and Brazil by telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. A study-derived score including clinical variables (sex, body mass, history of hypertension, coronary disease, heart failure, heart surgery, valve disease and Chagas disease) was applied, and the reclassification rates from intermediate (13% to 69%) to high (?70%) and low (<13%) risk after screening echo were assessed, as well as the accuracy of the final risk classification to predict HD in standard echo.Results:Total 3252 patients underwent screening echo; 1114 (34%) from SC groups, and 489 underwent standard echo. Mean age was 53?17 years, 66% were women; 43.1% had hypertension, 20.4% diabetes. In screening, significant HD was found in 28.1% in SC vs. 32.1% in RF group, p=0.02. Previously to screening echo, 2396 (74%) patients were classified as moderate risk and 856 (26%) as high risk. Screening echo reclassified 28% of moderate-risk patients to low-risk, and 3.9% to high-risk, and 54.3% of those of high risk to moderate risk. A final high-risk score (>70%) had an overall sensitivity of 73% (95% CI 64 - 80) and specificity of 99% (95% CI 96 - 100) to predict HD in standard echo. Screening echo significantly improved overall score accuracy from 63% (95% CI 59 - 68) to 90% (95% CI 87 - 93).Conclusions:Screening echo in PC is a promising prioritization strategy in low resourced areas, through task-shifting. It?s utilization in combination with clinical variables has good accuracy to predict high risk of significant HD.