Accuracy of general practitioners’ readings of ECG in primary care

Santos, Paulo; Pessanha, Paulo; Viana, Marcelo; Campelo, Manuel; Nunes, José Pedro L.; Hespanhol, Alberto; Macedo, Filipe; Couto, Luciana

doi:10.2478/s11536-013-0288-9

Cited by 7 publications

(14 citation statements)

References 17 publications

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“…Despite the good performance of GPs in recognising atrial fibrillation, sick sinus syndrome, old myocardial infarction, left bundle branch block and paroxysmal supraventricular tachycardia (which is consistent with current literature) [2, 3, 5, 6, 14, 28], many false abnormalities were seen, and incomplete right bundle branch block and left anterior fascicular block were frequently missed. These QRS abnormalities have few clinical consequences, and the criteria are much more susceptible to inter-individual interpretation [20, 21].…”

Section: Discussionsupporting

confidence: 85%

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Competence of general practitioners in requesting and interpreting ECGs - a case vignette study

et al. 2018

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BackgroundPerforming electrocardiography is common in general practice, but the quality of indication setting and diagnostic accuracy have been disputed.ObjectivesTo assess the competence of general practitioners (GPs) in their decision-making process with regard to recording and interpreting an electrocardiogram (ECG) and evaluating the relevance of the result for management.MethodsAn online case vignette survey was performed among GPs and cardiologists (in 2015). Nine cases describing situations for which Dutch clinical guidelines recommend or advise against recording an ECG were presented. In each case, the participant had to make choices on recording an ECG, interpreting it, and using the result in a management decision. The reference standard for each ECG diagnosis was set by the expert author team.ResultsFifty GPs who interpret ECGs themselves, eight GPs who do not and 12 cardiologists completed the survey. Adherence to guidelines recommending an ECG was high for suspected atrial fibrillation, suspected arrhythmia present during consultation, including bradycardia, but much lower for progressive heart failure and stable angina. Diagnostic accuracy of GPs was best in atrial fibrillation (96%), sick sinus syndrome (85%) and old myocardial infarction (82%), but poor in left anterior fascicular block (16%) and incomplete right bundle branch block (10%). GPs often acknowledged the low relevance of the results of a non-indicated ECG.ConclusionGPs do not fully adhere to Dutch cardiovascular guidelines on indications for recording ECGs. Diagnostic accuracy was high for atrial fibrillation, sick sinus syndrome and old myocardial infarction and poor for left anterior fascicular block and incomplete right bundle branch block.Electronic supplementary materialThe online version of this article (10.1007/s12471-018-1124-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 85%

“…These studies report that the diagnostic accuracy of GPs in interpreting ECGs is limited but varies widely. Agreement between GPs and cardiologists varied from 59–80% [3, 13, 14]. …”

Section: Introductionmentioning

confidence: 99%

Competence of general practitioners in requesting and interpreting ECGs - a case vignette study

et al. 2018

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“…Portugalu, Paolo Santos i saradnici kažu da je EKG dijagnostika česta u radu lekara opšte medicine [3]. Skoro 50% uraĎenih EKG pregleda kod pregledanih pacijenta u našem istraživanju pokazuje u kojoj meri je čest EKG pregled u ovoj ambulanti.…”

Section: Grupaunclassified

“…postoje "zajednički-ubrojeni u svaku grupu. Analizirajući tegobe naših pacijenata -bol u grudima i ubrzan, odnosno nepravilan rad srca i uporedivši ih sa rezultatima u prethodno objavljenim radovima [5,3], ukazujemo na priblizno isti procenat. Studija u Portugaliji[5] je rezultirala sa 36,6 % pacijenata koji su se žalili na bol u grudima, kao i 23,3% sa lupanjem srca.…”

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Symptoms that required ECG diagnostics in the ambulatory unit of the city institute for urgent medical care Belgrade

Plazinić¹,

Živanović²

2017

ABC - čas urg medicine

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Kod kojih tegoba se radi ekg dijagnostika u ambulanti GZZHMP Beograd Sažetak:Uvod: Ambulanta Gradskog zavoda za hitnu medicinsku pomoć Beograd (GZZHMP) pripada primarnoj zdravstvenoj zaštiti, opremljena je EKG aparatom. EKG dijagnostika se radi svakodnevno, kod različitih tegoba, a pacijenti koji dolaze u ambulantu su najčešće tu prvi put, nepoznati su lekaru koji radi i najčešće bez prateće medicinske dokumentacije. Kod pregleda pacijenti žele da znaju ne samo šta se sa njima dešava, već i da li je to ozbiljno. EKG dijagnostika često razrešava ovu dilemu. Cilj:Prikazati kod kojih tegoba je pacijentima raĎena EKG dijagnostika u ambulanti GZHMP Metodologija: Korišćena je elektronska baza podataka ambulante Gradskog zavoda za hitnu medicinsku pomoć Beograd, u periodu od 01-22 januara 2015.godine na pregledanih 206 pacijenata. Analizirane su upisane tegobe onih pacijenata kojima je uraĎena EKG dijagnostika; jedan pacijent je mogao imati više od jedne tegobe navedenu u istraživanju.Rezultati: Kod 206 pacijenata u datom periodu, u skoro 50% pregledanih je uraĎena EKG dijagnostika. Razlog rada EKG dijagnostike su žalbe na: povišeni arterijski pritisak, bol u grudima i druge tegobe u grudima, kao npr. gušenje, kašalj, ubrzan ili nepravilan srčani rad, potom glavobolja i vrtoglavice, trnjenje ruku, mučnine, povišena telesna temperatura. UporeĎujući tegobe iz različitih grupa, koje najčešće ukazuju na bolesti kardiovaskularnog respiratornog i centralnog nervnog sistema, nema statističke razlike meĎu njima.Zaključak: Najčešća pojedinačna indikacija za EKG dijagnostiku kod naših pacijenata je povišen krvni pritisak, potom bol tj. tegoba u grudima, nepravilan i ubrzan rad srca, glavobolje, odnosno vrtoglavice. Samo 10% pacijenata je upućen internisti na dalju dijagnostiku u lečenje.

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Interpretations of and management actions following electrocardiograms in symptomatic patients in primary care: a retrospective dossier study

et al. 2019

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BackgroundThe electrocardiogram (ECG) has become a popular tool in primary care. The clinical value of the ECG depends on the appropriateness of the indication and the interpretation skills of the general practitioner (GP).ObjectivesTo describe the use of electrocardiography in primary care and to assess the performance of GPs in interpreting ECGs and making subsequent management decisions.MethodsThree hundred ECGs, recorded during daily practice in symptomatic patients by 14 GPs who regularly perform electrocardiography, were selected. Corresponding data of the indications, interpretations and subsequent management actions were extracted from the associated medical records. A panel consisting of an expert GP and a cardiologist reviewed the ECGs and specified their agreement with the findings and actions of the study GPs.ResultsThe most common indications were suspicion of a rhythm abnormality (43.7%), ischaemic heart disease (42.7%) and patient reassurance (14.3%). The study GPs interpreted 53.3% of the ECGs as showing no (new or acute) abnormality, whereas supraventricular rhythm disorders (12.3%), conduction disorders (7.7%) and repolarisation disorders (7.0%) were the most frequently reported pathological findings. Overall, the expert panel disagreed with the interpretations of the study GPs in 16.2% of cases, and with the GPs’ management actions in 11.7%. Learning goals for GPs performing electrocardiography could be formulated for acute coronary syndrome, rhythm disorders, pulmonary embolism, reassurance, left ventricular hypertrophy and premature ventricular complexes.ConclusionGPs who feel competent in electrocardiography performed well in the opinion of the expert panel. We formulated various learning objectives for GPs performing electrocardiography.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-01306-y) contains supplementary material, which is available to authorized users.

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Accuracy of general practitioners’ readings of ECG in primary care

Abstract: Abstract

Cited by 7 publications

References 17 publications

Competence of general practitioners in requesting and interpreting ECGs - a case vignette study

Competence of general practitioners in requesting and interpreting ECGs - a case vignette study

Symptoms that required ECG diagnostics in the ambulatory unit of the city institute for urgent medical care Belgrade

Interpretations of and management actions following electrocardiograms in symptomatic patients in primary care: a retrospective dossier study

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