Accuracy of general practitioners’ readings of ECG in primary care
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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.
To evaluate accuracy of ECG readings done by GPs by comparison with those done by a cardiologist as the gold standard.
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.
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%.
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.
KeywordsCardiovascular 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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- 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
- 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
- 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
- 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