Electrocardiogram interpretation in general practice
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Electrocardiogram interpretation in general practice. background. Common diagnostic test in GP (cardiac complaints) Difficulties of interpreting ECG: GP and residents > cardiologists More correct interpretation of ECG achieved by using interpretative ECG recorders. Objectives.

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Electrocardiogram interpretation in general practice

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Electrocardiogram interpretation in general practice

Electrocardiogram interpretation in general practice


Background

background

  • Common diagnostic test in GP (cardiac complaints)

  • Difficulties of interpreting ECG: GP and residents > cardiologists

  • More correct interpretation of ECG achieved by using interpretative ECG recorders


Objectives

Objectives

  • To know the sensitivity and the specificity of ECG interpretation by both GPs and interpretative recorders.


Methods

Methods

  • Setting: Ebeltoft, Denmark

  • Population: 902 ECGs (randomised aged 31-51 population)

  • Cross-sectional study

  • Gold standard: cardiologist ‘s interpretation

  • GPs not blinded to:

    • Results of interpretive ECG recorder

    • History and other clinical data

  • Cardiologist not blinded to:

    • Results of interpretive ECG recorder


Methods1

Methods

  • 10 % of random sample of ECG viewed by an other cardiologist,

  • Statistic tool: SPSS,

  • McNemar’s test: sensitivity and specificity of diagnoses made by both GPs and ECG recorders,

  • Kappa: interobserver agreement on the diagnoses made by two cardiologists.


Results

Results

  • 902 of 905 ECGs

  • 429 men (47.6%), 473 women (52.4%)

  • Median age: 41 years (men and women)

  • Kappa = 0.856 (95% CI: 0.742-0.970)


Results abnormal ecg

Results abnormal ECG


Results abnormal ecg1

Results abnormal ECG

  • If the sensitivity = 69.8%


Results abnormal ecg2

Results abnormal ECG


Results abnormal ecg3

Results abnormal ECG


Results ischaemia or myocardial infarction

Results ischaemia or myocardial infarction


Results any bundle branch

Results any bundle branch

  • Sensitivity and specificity: no significant difference


Conclusions

Conclusions

  • Higher sensitivity with ECG recorder than with GPs  false-negative low for recoder

     stay very low in general

     the GP have to attempt to achieve a better sensitivity (abnormal ECG reading by the recorder to a specialist, a training,…)

  • Higher specificity with GPs than with ECG recorder


Conclusions1

Conclusions

  • PPV: low

  • PNV: high

  • Low prevalence of abnormal ECG in this population


Positive point

Positive point

  • GPs never knew that their ECG interpretation skills will be evaluated  real skills of the GPs


Negative points

Negative points

  • Not blinding of the GPs

  • Not blinding of the cardiologist

  • The same training in Belgium and in Denmark?

  • One ECG recorder; and the other ones?


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