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

Abstract

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.

Novel tech throws knock-out punch to ECG improving GP referral decisions to cardiology

“…The overall reference send rate was 43.0%, which is an important cardiac condition property of the included patient population. This referral to cardiologist care rate is similar to that of other studies, confirmed by the literature, with a typical range of 30%–50% 17–20…”

“…This referral to cardiologist care rate is similar to that of other studies, confirmed by the literature, with a typical range of 30%-50%. [17][18][19][20]…”

Screening and detection of atrial fibrillation in primary care: current practice and future perspectives

“… 20 , 21 This is supported by work where GPs’ interpretation of 12-lead ECG was compared with cardiologist or expert panel interpretation, where GPs struggled with diagnosing repolarization disorders but were highly accurate in AF detection. 22–24 Practice nurses felt less confident in diagnosing or ruling out AF than GPs. 20 The emergence and dissemination of single-lead devices has provided a new challenge in terms of independent ECG interpretation by GPs, as accuracy in diagnosing AF has so far been less accurate, 25 prompting the recommendation to have suspected positive AF single-lead ECG readings confirmed by a cardiologist.…”

General Practitioners’ Perspectives on Appropriate Use of Ultrasonography in Primary Care in Denmark: A Multistage Mixed Methods Study

“…Patients seem to appreciate the use of POCUS, 37,38 but questions remain regarding the reliability and diagnostic accuracy of a GP POCUS scan 30 and the challenges of evaluating and monitoring technology based in the community. 39,40 Until data is available for developing evidence-based guidelines 11 about appropriate and inappropriate POCUS use in general practice, interim experience-based recommendations based on basic ethical clinical principles, eg, primum non nocere (first, do no harm), may guide and encourage prudence among GPs (Figures 1-4).…”