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Electrocardiogram interpretation in general practice

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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  1. Electrocardiogram interpretation in general practice

  2. 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

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

  4. 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

  5. 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.

  6. 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)

  7. Results abnormal ECG

  8. Results abnormal ECG • If the sensitivity = 69.8%

  9. Results abnormal ECG

  10. Results abnormal ECG

  11. Results ischaemia or myocardial infarction

  12. Results any bundle branch • Sensitivity and specificity: no significant difference

  13. 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

  14. Conclusions • PPV: low • PNV: high • Low prevalence of abnormal ECG in this population

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

  16. 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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