Variation in Routine Electrocardiogram Use in Academic Primary Care Practice

Abstract

Variations in ECG ordering are not explained by patient characteristics. The tremendous nonclinical variations in ECG test ordering suggest a need for greater consensus about use of screening ECGs in primary care.

The potential yield of ECG screening of hypertensive patients: the Utrecht Health Project

“…In a study in 10 primary care internal medicine group practices in Boston, in 7.8% of 24 014 hypertensive patients, a screening ECG was performed [37]. In a questionnaire survey among 120 Dutch general practitioners, an ECG was not often considered in the assessment of a hypertensive patient [38].…”

Screening Strategies for Cardiovascular Disease in Asymptomatic Adults

“…In one study of 10 urban academic group internal medicine practices, ECGs were obtained in 4.4% of asymptomatic patients without known CVD. 89 There was significant variability among both group practices and providers, with the rate of ECG performance ranging from 0.8-8.6% among the 10 practices, and from 0.0-24% among providers. 89 Clinical predictors of ECG use include older age, male sex, and clinical comorbidities.…”

“…89 There was significant variability among both group practices and providers, with the rate of ECG performance ranging from 0.8-8.6% among the 10 practices, and from 0.0-24% among providers. 89 Clinical predictors of ECG use include older age, male sex, and clinical comorbidities. Additionally, older male providers, those who billed for ECG interpretation, and Medicare as a payment source were associated with obtaining ECGs.…”

“…Additionally, older male providers, those who billed for ECG interpretation, and Medicare as a payment source were associated with obtaining ECGs. 89 Race and ethnicity were not analyzed as predictors of ECG screening. 89 Overall, variation in ECG screening was not well explained by patient characteristics, and likely reflects the lack of sufficient evidence for the role of ECG screening in the primary care setting.…”

“…89 Race and ethnicity were not analyzed as predictors of ECG screening. 89 Overall, variation in ECG screening was not well explained by patient characteristics, and likely reflects the lack of sufficient evidence for the role of ECG screening in the primary care setting. 89 …”