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Central European Journal of Medicine

, Volume 9, Issue 3, pp 431–436 | Cite as

Accuracy of general practitioners’ readings of ECG in primary care

  • Paulo Santos
  • Paulo Pessanha
  • Manuel Viana
  • Manuel Campelo
  • José Pedro Nunes
  • Alberto Pinto Hespanhol
  • Filipe Macedo
  • Luciana Couto
Research Article
  • 80 Downloads

Abstract

Background

The electrocardiogram (ECG) is a diagnostic test commonly used in daily Primary Care practice. General Practitioners (GP) often feel unsure about their interpretation of ECGs, so they engage external services to provide it.

Aim

To evaluate accuracy of ECG readings done by GPs by comparison with those done by a cardiologist as the gold standard.

Methods

We studied 195 ECGs collected consecutively during first semester of 2010 in an urban Health Centre of Portugal. Each ECG was read by each physician and inter-observer agreement was evaluated. After coding by Novacode, sensitivity and specificity of GP’s readings were calculated.

Results

Inter-observer agreement between GP readings was “good” with an intraclass correlation coefficient of 0.727 (CI 95%: 0.670–0.779). When compared with gold standard, GP achieved a “good” agreement with an intraclass correlation coefficient of 0.712 (CI 95%: 0.659–0.762). The overall accuracy of GP for detecting abnormalities was 81.0% (95%CI: 75.7–85.6%), with a sensitivity of 84.8% (95%CI: 77.3–90.6%) and a specificity of 77.5% (95%CI: 69.7–84.2%). For normal tests, accuracy was 79.9% (95%CI: 74.7–84.3). In the most prevalent classes of abnormalities, accuracy was higher than 90%.

Conclusion

GP showed good skills in reading ECGs in their practice of Primary Care. Better attention should be given to ischemic abnormalities present on ECGs. Key message: General Practitioners demonstrate good skills for reading the ECGs of patients on a primary care centre when compared to the gold standard defined by a cardiologist reading.

Keywords

Cardiovascular Disorders / Hypertension / DVT / Atherosclerosis Continuing Medical Education Diagnostic Tests Graduate Medical Education / Fellowship Training Physician Competency Primary Care Quality of Care Measurement/ Psychometric Analyses Observational Research 

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References

  1. [1]
    Einthoven W. Galvanometrische registratie van het menschilijk electrocardiogram. 1902 [24/04/2010]; 101-7]. Available from: http://www.ecglibrary.comurl Google Scholar
  2. [2]
    Jensen MS, Thomsen JL, Jensen SE, Lauritzen T, Engberg M. Electrocardiogram interpretation in general practice. Fam Pract. 2005;22(1):109–113. Epub 2004/11/06PubMedCrossRefGoogle Scholar
  3. [3]
    Macallan DC, Bell JA, Braddick M, Endersby K, Rizzo-Naudi J. The electrocardiogram in general practice: its use and its interpretation. J R Soc Med. 1990;83(9):559–562. Epub 1990/09/01PubMedCentralPubMedGoogle Scholar
  4. [4]
    Sur DK, Kaye L, Mikus M, Goad J, Morena A. Accuracy of electrocardiogram reading by family practice residents. Fam Med. 2000;32(5):315–319. Epub 2000/05/23PubMedGoogle Scholar
  5. [5]
    Mant J, Fitzmaurice DA, Hobbs FD, Jowett S, Murray ET, Holder R, et al. Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial. BMJ. 2007;335(7616):380. Epub 2007/07/03PubMedCentralPubMedCrossRefGoogle Scholar
  6. [6]
    Jones R. Electrocardiographic diagnosis in general practice. Practitioner. 1984;228(1387):85–87. Epub 1984/01/01PubMedGoogle Scholar
  7. [7]
    Houghton AR, Sparrow NJ, Toms E, Cowley AJ. Should general practitioners use the electrocardiogram to select patients with suspected heart failure for echocardiography? Int J Cardiol. 1997;62(1):31–36PubMedCrossRefGoogle Scholar
  8. [8]
    Kadish AH, Buxton AE, Kennedy HL, Knight BP, Mason JW, Schuger CD, et al. ACC/AHA clinical competence statement on electrocardiography and ambulatory electrocardiography: A report of the ACC/AHA/ACP-ASIM task force on clinical competence (ACC/AHA Committee to develop a clinical competence statement on electrocardiography and ambulatory electrocardiography) endorsed by the International Society for Holter and noninvasive electrocardiology. Circulation. 2001;104(25):3169–3178. Epub 2001/12/19PubMedGoogle Scholar
  9. [9]
    Salerno SM, Alguire PC, Waxman HS. Competency in interpretation of 12-lead electrocardiograms: a summary and appraisal of published evidence. Ann Intern Med. 2003;138(9):751–760. Epub 2003/05/06PubMedCrossRefGoogle Scholar
  10. [10]
    Hespanhol A, Malheiro A, Pinto AS. O Projecto «Tubo de Ensaio» — breve história do Centro de Saúde S. João. Rev Port Clin Geral. 2002;18:171–186Google Scholar
  11. [11]
    Martin-Rioboo E, Lopez Granados A, Cea Calvo L, Perula De Torres LA, Garcia Criado E, Anguita Sanchez MP, et al. [Interobserver agreement on electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients in Andalusia. PREHVIA study]. Aten Primaria. 2009;41(5):248–254. Epub 2009/04/28. Concordancia entre observadores en el diagnostico electrocardiografico de la hipertrofia ventricular izquierda en hipertensos de Andalucia. Estudio PREHVIAPubMedCrossRefGoogle Scholar
  12. [12]
    Rautaharju PM, Park LP, Chaitman BR, Rautaharju F, Zhang ZM. The Novacode criteria for classification of ECG abnormalities and their clinically significant progression and regression. J Electrocardiol. 1998;31(3):157–187. Epub 1998/07/31PubMedCrossRefGoogle Scholar
  13. [13]
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174PubMedCrossRefGoogle Scholar
  14. [14]
    American Academy of Family Physicians Policy Manual. Family Physician Interpretation of Electrocardiograms. www.aafp.org: American Academy of Family Physicians; 2008Google Scholar
  15. [15]
    Houghton-Allen B. A penile clamp for retrograde urethrography using external compression by a balloon catheter. Australasian radiology. 1997;41(1):6PubMedCrossRefGoogle Scholar
  16. [16]
    White T, Woodmansey P, Ferguson DG, Channer KS. Improving the interpretation of electrocardiographs in an accident and emergency department. Postgrad Med J. 1995;71(833):132–135. Epub 1995/03/01PubMedCentralPubMedCrossRefGoogle Scholar
  17. [17]
    Hatala R, Norman GR, Brooks LR. Impact of a clinical scenario on accuracy of electrocardiogram interpretation. J Gen Intern Med. 1999;14(2):126–129. Epub 1999/03/03PubMedCrossRefGoogle Scholar
  18. [18]
    Hatala RA, Norman GR, Brooks LR. The effect of clinical history on physicians’ ECG interpretation skills. Acad Med. 1996;71(10 Suppl):S68–70. Epub 1996/10/01PubMedCrossRefGoogle Scholar
  19. [19]
    Grum CM, Gruppen LD, Woolliscroft JO. The influence of vignettes on EKG interpretation by third-year students. Academic Medicine. 1993;68(10):S61–63.PubMedCrossRefGoogle Scholar
  20. [20]
    Patel PM, Wu WC. The electrocardiogram in the primary care office. Prim Care. 2005;32(4):901–930, vi. Epub 2005/12/06PubMedCrossRefGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Paulo Santos
    • 1
    • 2
  • Paulo Pessanha
    • 2
  • Manuel Viana
    • 2
  • Manuel Campelo
    • 1
    • 3
  • José Pedro Nunes
    • 1
    • 3
  • Alberto Pinto Hespanhol
    • 2
  • Filipe Macedo
    • 1
    • 3
  • Luciana Couto
    • 2
  1. 1.Faculty of Medicine of University of PortoPortoPortugal
  2. 2.Department of Social Sciences and HealthFaculty of Medicine of University of PortoPortoPortugal
  3. 3.Cardiology service HSJEPE PortoPortoPortugal

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