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

Compiet, S. A. M.; Willemsen, Robert; Konings, Karen; Stoffers, Jelle

doi:10.1007/s12471-018-1124-2

Cited by 14 publications

(23 citation statements)

References 21 publications

(31 reference statements)

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“…GPs judged that they have sufficient knowledge and experience to diagnose AF. Research by Compiet et al shows that the diagnostic accuracy of GPs to detect AF is indeed high (96%) [15]. When comparing current results to our previous study among cardiologists, we see that monitoring devices are more often available to cardiologists than to GPs, as is to be expected [12].…”

Section: Discussionsupporting

confidence: 79%

How do Dutch general practitioners detect and diagnose atrial fibrillation? Results of an online case vignette study

et al. 2019

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BackgroundDetection and treatment of atrial fibrillation (AF) are important given the serious health consequences. AF may be silent or paroxysmal and remain undetected. It is unclear whether general practitioners (GPs) have appropriate equipment and optimally utilise it to detect AF. This case vignette study aimed to describe current practice and to explore possible improvements to optimise AF detection.MethodsBetween June and July 2017, we performed an online case vignette study among Dutch GPs. We aimed at obtaining at least 75 responses to the questionnaire. We collected demographics and asked GPs’ opinion on their knowledge and experience in diagnosing AF. GPs could indicate which diagnostic tools they have for AF. In six case vignettes with varying symptom frequency and physical signs, they could make diagnostic choices. The last questions covered screening and actions after diagnosing AF. We compared the answers to the Dutch guideline for GPs on AF.ResultsSeventy-six GPs completed the questionnaire. Seventy-four GPs (97%) thought they have enough knowledge and 72 (95%) enough experience to diagnose AF. Seventy-four GPs (97%) could order or perform ECGs without the interference of a cardiologist. In case of frequent symptoms of AF, 36–40% would choose short-term (i.e. 24–48 h) and 11–19% long-term (i.e. 7 days, 14 days or 1 month) monitoring. In case of non-frequent symptoms, 29–31% would choose short-term and 21–30% long-term monitoring. If opportunistic screening in primary care proves to be effective, 83% (58/70) will support it.ConclusionsResponding GPs report to have adequate equipment, knowledge, and experience to detect and diagnose AF. Almost all participants can order ECGs. Reported monitoring duration was shorter than recommended by the guideline. AF detection could improve by increasing the monitoring duration.

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Section: Discussionsupporting

confidence: 79%

How do Dutch general practitioners detect and diagnose atrial fibrillation? Results of an online case vignette study

et al. 2019

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“…3). In addition, our previous vignette study on the competence of GPs in requesting and interpreting ECGs revealed that GPs showed poor diagnostic accuracy for left anterior fascicular block and incomplete right bundle branch block [24].…”

Section: Discussionmentioning

confidence: 99%

“…We expect these will support future ECG training for GPs. The first study addressed the competence of GPs in requesting and interpreting ECGs by means of a case vignette study [24]. In the remaining three studies, we have focussed on the performance of GPs in various real-life situations: ECGs recorded during out-of-office hours (to be published), ECGs performed during primary care cardiovascular risk management programmes (to be published) and ECGs carried out in symptomatic patients during day-care practice (this study).…”

Section: Introductionmentioning

confidence: 99%

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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“…The GPs also described false abnormalities in the ECG tracings. 7 The implication of these study findings was that areas of poor competence amongst the GPs could be established and followed by appropriate intervention measures.…”

Section: Introductionmentioning

confidence: 88%

Generalist practitioners’ self-rating and competence in electrocardiogram interpretation in South Africa

Mabuza

Mntla

2020

Afr. j. prim. health care fam. med.

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Background: Electrocardiogram (ECG) is the only practical, non-invasive method of recording and analysing cardiac abnormalities. It enables a primary healthcare (PHC) clinician to detect cardiac and non-cardiac abnormalities, some potentially life-threatening. Their early detection could save a patient’s life.Aim: The aim of this study was to evaluate the competence of generalist practitioners in ECG interpretation.Setting: This study was conducted at the Annual Refresher Course, Council for Scientific and Industrial Research (CSIR), Pretoria.Methods: A cross-sectional study was conducted amongst 93 generalist practitioners, using a self-administered questionnaire containing 20 ECG tracings, commonly encountered in PHC. The tracings were categorised into primary ECG parameters, ECG emergencies and common ECG abnormalities. Competence was determined by the generalist practitioner’s number of correctly interpreted ECG tracings. Data associations were computed using the Fisher’s exact test. Statistical significance was set at p ≤ 0.05.Results: Correct heart rate calculation was achieved by 14/83 (16.9%), ECG rhythm by 7/83 (8.4%), acute antero-septal myocardial infarction (MI) by 29/83 (34.9%), atrial fibrillation by 19/83 (22.9%) and cute inferior MI by 22/83 (26.5%) generalist practitioners. No correlation was found between the practitioners’ number of years in practice and competence in ECG interpretation (p 0.05). The total number of correct answers achieved by all practitioners was 274/1860 (14.7%).Conclusion: The generalist practitioners had poor competency on ECG interpretation regardless of the number of years in practice. Their poor self-rating corresponded with the number of correct answers they provided. There is a need for continuous education in ECG interpretation.

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

Cited by 14 publications

References 21 publications

How do Dutch general practitioners detect and diagnose atrial fibrillation? Results of an online case vignette study

How do Dutch general practitioners detect and diagnose atrial fibrillation? Results of an online case vignette study

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

Generalist practitioners’ self-rating and competence in electrocardiogram interpretation in South Africa

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