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Brik T, Harskamp RE, Himmelreich JCL. Screening and detection of atrial fibrillation in primary care: current practice and future perspectives. Eur Heart J Suppl 2024; 26:iv12-iv18. [PMID: 39099572 PMCID: PMC11292407 DOI: 10.1093/eurheartjsupp/suae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Atrial fibrillation (AF) is a common arrhythmia associated with an increased risk of stroke, which can be effectively reduced by prophylaxis initiation and integrated care to reduce cardiovascular risk and AF-related complications. Screening for AF has the potential to improve long-term clinical outcomes through timely AF detection in asymptomatic patients. With the central role of primary care in most European healthcare systems in terms of disease detection, treatment, as well as record keeping, primary care is ideally situated as a setting for AF screening efforts. In this review, we provide an overview of evidence relating to AF screening in primary care. We discuss current practices of AF detection and screening, evidence from AF screening trials conducted in primary care settings, stakeholder views on barriers and facilitators for AF screening in primary care, and important aspects that will likely shape routine primary care AF detection as well as AF screening efforts. Finally, we present a potential outline for a primary care-centred AF screening trial coupled to integrated AF care that could further improve the benefit of AF screening.
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Affiliation(s)
- Tessa Brik
- Department of General Practice, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Personalized Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Personalized Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health, Personalized Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Khalifa AA, Khidr SS, Hassan AAA, Mohammed HM, El-Sharkawi M, Fadle AA. Can Orthopaedic Surgeons adequately assess an Electrocardiogram (ECG) trace paper? A cross sectional study. Heliyon 2023; 9:e22617. [PMID: 38046166 PMCID: PMC10686838 DOI: 10.1016/j.heliyon.2023.e22617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives The primary objective was to evaluate the ECG trace paper evaluation current knowledge level in a group of Orthopaedic surgeons divided into juniors and seniors according to M.D. degree possession. Methods A cross sectional study through self-administered questionnaires at a university hospital Orthopaedic and Trauma Surgery Department. The questionnaire included five sections: 1-Basic participants' characteristics, 2-Participants' perception of their ECG evaluation current knowledge level, 3-The main body of the questionnaire was an ECG quiz (seven); the participant was asked to determine if it was normal and the possible diagnosis, 4-Participants' desired ECG evaluation knowledge level, and 5-Willingness to attend ECG evaluation workshops. Results Of the 121 actively working individuals in the department, 96 (97.3 %) finished the questionnaire, and 85 (77.3 %) were valid for final evaluation. The participants' mean age was 30.4 ± 6.92 years, 76.5 % juniors and 23.5 % seniors. 83.5 % of the participants perceived their current ECG evaluation knowledge as none or limited. For participants' ability to evaluate an ECG, higher scores were achieved when determining if the ECG was normal or abnormal, with a mean score percentage of 79.32 % ± 23.27. However, the scores were lower when trying to reach the diagnosis, with a mean score percentage of 43.02 % ± 27.48. There was a significant negative correlation between the participant's age and answering the normality question correctly (r = -0.277, p = 0.01); and a significant positive correlation between answering the diagnosis question correctly and the desired level of knowledge and the intention to attend a workshop about ECG evaluation, r = 0.355 (p = 0.001), and r = 0.223 (p = 0.04), respectively. Only 56.5 % of the participants desired to get more knowledge, and 81.2 % were interested in attending ECG evaluation workshops. Conclusion Orthopaedic surgeons showed sufficient knowledge when determining the normality of ECG trace papers; however, they could not reach the proper diagnosis, and Junior surgeons performed slightly better than their senior peers. Most surgeons are willing to attend ECG evaluation and interpretation workshops to improve their knowledge level.
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Affiliation(s)
- Ahmed A. Khalifa
- Orthopaedic Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Shimaa S. Khidr
- Cardiology Department, Assiut University Hospital, Assiut, Egypt
| | | | - Heba M. Mohammed
- Public Health and Community Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammad El-Sharkawi
- Orthopaedic and Trauma Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amr A. Fadle
- Orthopaedic and Trauma Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Himmelreich JC, Harskamp RE. Diagnostic accuracy of the PMcardio smartphone application for artificial intelligence-based interpretation of electrocardiograms in primary care (AMSTELHEART-1). CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023; 4:80-90. [PMID: 37351331 PMCID: PMC10282008 DOI: 10.1016/j.cvdhj.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Background The use of 12-lead electrocardiogram (ECG) is common in routine primary care, however it can be difficult for less experienced ECG readers to adequately interpret the ECG. Objective To validate a smartphone application (PMcardio) as a stand-alone interpretation tool for 12-lead ECG in primary care. Methods We recruited consecutive patients who underwent 12-lead ECG as part of routinely indicated primary care in the Netherlands. All ECGs were assessed by the PMcardio app, which analyzes a photographed image of 12-lead ECG for automated interpretation, installed on an Android platform (Samsung Galaxy M31) and an iOS platform (iPhone SE2020). We validated the PMcardio app for detecting any major ECG abnormality (MEA, primary outcome), defined as atrial fibrillation/flutter (AF), markers of (past) myocardial ischemia, or clinically relevant impulse and/or conduction abnormalities; or AF (key secondary outcome) with a blinded expert panel as reference standard. Results We included 290 patients from 11 Dutch general practices with median age 67 (interquartile range 55-74) years; 48% were female. On reference ECG, 71 patients (25%) had MEA and 35 (12%) had AF. Sensitivity and specificity of PMcardio for MEA were 86% (95% CI: 76%-93%) and 92% (95% CI: 87%-95%), respectively. For AF, sensitivity and specificity were 97% (95% CI: 85%-100%) and 99% (95% CI: 97%-100%), respectively. Performance was comparable between Android and iOS platform (kappa = 0.95, 95% CI: 0.91-0.99 and kappa = 1.00, 95% CI: 1.00-1.00 for MEA and AF, respectively). Conclusion A smartphone app developed to interpret 12-lead ECGs was found to have good diagnostic accuracy in a primary care setting for major ECG abnormalities, and near-perfect properties for diagnosing AF.
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Affiliation(s)
- Jelle C.L. Himmelreich
- Address reprint requests and correspondence: Dr Jelle C.L. Himmelreich, Amsterdam UMC, locatie AMC, Afdeling Huisartsgeneeskunde, kamer J2-219, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Bdair IA. Electrocardiogram interpretation competency among undergraduate nursing students: A quasi-experimental study. Nurs Forum 2022; 57:1273-1280. [PMID: 35997263 DOI: 10.1111/nuf.12790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/25/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac diseases are highly prevalent. Electrocardiogram (ECG) is a noninvasive, rapid, safe, and low-cost procedure that is commonly used by nurses in clinical settings to diagnose a variety of cardiac arrhythmia. However, there is a limited number of studies that have assessed nursing students' competencies in electrocardiogram interpretation in Saudi Arabia. This study aimed to assess the electrocardiogram interpretation competency among undergraduate nursing students and to evaluate the effectiveness of the electrocardiogram interpretation educational program. METHODS A quasi-experimental pre-post-test design was conducted. A pre-post-test self-administered standardized questionnaire was completed by a convenient sample of 79 nursing students who enrolled in an educational program. Data were analyzed using descriptive and inferential statistics with p < .05 was assumed. The study hypothesized that ECG competency scores of nursing students who are enrolled in an educational program will be higher in post-test than their pre-test scores. RESULTS The vast majority of students (96.2%) expressed their interest to enroll in more ECG training sessions. The study results showed that students' mean ECG interpretation competency was 4.16 (1.88) and 7.43 (2.38) in pre- and post-tests, respectively, with a statistical significance of p < .001. CONCLUSION Overall performance of nursing students was limited. Study results confirm the primary hypothesis that the educational program was effective in improving students' ECG interpretation competencies. More ECG contents and programs should be integrated into nursing curricula and more follow-up studies are recommended. This study highlighted the significance of equipping nursing students with ECG interpretation competencies through education and training to ensure safe practice.
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Affiliation(s)
- Izzeddin A Bdair
- Department of Nursing, Al-Ghad International Colleges for Applied Medical Sciences, Riyadh, KSA
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Cook DA, Oh SY, Pusic MV. Assessments of Physicians' Electrocardiogram Interpretation Skill: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:603-615. [PMID: 33913438 DOI: 10.1097/acm.0000000000004140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To identify features of instruments, test procedures, study design, and validity evidence in published studies of electrocardiogram (ECG) skill assessments. METHOD The authors conducted a systematic review, searching MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, ERIC, and Web of Science databases in February 2020 for studies that assessed the ECG interpretation skill of physicians or medical students. Two authors independently screened articles for inclusion and extracted information on test features, study design, risk of bias, and validity evidence. RESULTS The authors found 85 eligible studies. Participants included medical students (42 studies), postgraduate physicians (48 studies), and practicing physicians (13 studies). ECG selection criteria were infrequently reported: 25 studies (29%) selected single-diagnosis or straightforward ECGs; 5 (6%) selected complex cases. ECGs were selected by generalists (15 studies [18%]), cardiologists (10 studies [12%]), or unspecified experts (4 studies [5%]). The median number of ECGs per test was 10. The scoring rubric was defined by 2 or more experts in 32 studies (38%), by 1 expert in 5 (6%), and using clinical data in 5 (6%). Scoring was performed by a human rater in 34 studies (40%) and by computer in 7 (8%). Study methods were appraised as low risk of selection bias in 16 studies (19%), participant flow bias in 59 (69%), instrument conduct and scoring bias in 20 (24%), and applicability problems in 56 (66%). Evidence of test score validity was reported infrequently, namely evidence of content (39 studies [46%]), internal structure (11 [13%]), relations with other variables (10 [12%]), response process (2 [2%]), and consequences (3 [4%]). CONCLUSIONS ECG interpretation skill assessments consist of idiosyncratic instruments that are too short, composed of items of obscure provenance, with incompletely specified answers, graded by individuals with underreported credentials, yielding scores with limited interpretability. The authors suggest several best practices.
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Affiliation(s)
- David A Cook
- D.A. Cook is professor of medicine and medical education, director of education science, Office of Applied Scholarship and Education Science, research chair, Mayo Clinic Rochester Multidisciplinary Simulation Center, and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633
| | - So-Young Oh
- S.-Y. Oh is assistant director, Program for Digital Learning, Institute for Innovations in Medical Education, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; ORCID: https://orcid.org/0000-0002-4640-3695
| | - Martin V Pusic
- M.V. Pusic is associate professor of emergency medicine and pediatrics, Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0001-5236-6598
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Rahimpour M, Shahbazi S, Ghafourifard M, Gilani N, Breen C. Electrocardiogram interpretation competency among emergency nurses and emergency medical service (EMS) personnel: A cross-sectional and comparative descriptive study. Nurs Open 2021; 8:1712-1719. [PMID: 33611852 PMCID: PMC8186699 DOI: 10.1002/nop2.809] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/24/2020] [Accepted: 01/31/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS The aim of this research study was to compare electrocardiogram (ECG) interpretation competency among emergency nurses and EMS personnel. DESIGN A cross-sectional comparative descriptive study design was used. METHODS This study recruited 170 participants (105 emergency nurses and 65 EMS personnel) in northwest of Iran. Data were collected during 2018 using ECG, an interpretation competency questionnaire and analysed using SPSS V.24 through independent t test, linear regression, Pearson and Spearman correlation coefficient. A statistical significance of p < .05 was assumed. RESULTS The study results showed a mean score of 6.65 ± 2.16 out of 10 for emergency nurses' and 4.87 ± 1.81 for EMS personnel ECG interpretation competency (p < .05). CONCLUSIONS Hospital emergency nurses were more qualified to interpret the ECG than the pre-hospital emergency medical personnel (p = .792 and β (SE)) = 0.22 (0.84). Active involvement in ECG interpretation and standard continued education are needed to develop and improve the emergency nurses and EMS personnel ECG interpretation competency.
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Affiliation(s)
- Maryam Rahimpour
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Shahbazi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery and Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Ghafourifard
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Cathal Breen
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Ulster, UK
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Cook DA, Oh SY, Pusic MV. Accuracy of Physicians' Electrocardiogram Interpretations: A Systematic Review and Meta-analysis. JAMA Intern Med 2020; 180:1461-1471. [PMID: 32986084 PMCID: PMC7522782 DOI: 10.1001/jamainternmed.2020.3989] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE The electrocardiogram (ECG) is the most common cardiovascular diagnostic test. Physicians' skill in ECG interpretation is incompletely understood. OBJECTIVES To identify and summarize published research on the accuracy of physicians' ECG interpretations. DATA SOURCES A search of PubMed/MEDLINE, Embase, Cochrane CENTRAL (Central Register of Controlled Trials), PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), ERIC (Education Resources Information Center), and Web of Science was conducted for articles published from database inception to February 21, 2020. STUDY SELECTION Of 1138 articles initially identified, 78 studies that assessed the accuracy of physicians' or medical students' ECG interpretations in a test setting were selected. DATA EXTRACTION AND SYNTHESIS Data on study purpose, participants, assessment features, and outcomes were abstracted, and methodological quality was appraised with the Medical Education Research Study Quality Instrument. Results were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Accuracy of ECG interpretation. RESULTS Of 1138 studies initially identified, 78 assessed the accuracy of ECG interpretation. Across all training levels, the median accuracy was 54% (interquartile range [IQR], 40%-66%; n = 62 studies) on pretraining assessments and 67% (IQR, 55%-77%; n = 47 studies) on posttraining assessments. Accuracy varied widely across studies. The pooled accuracy for pretraining assessments was 42.0% (95% CI, 34.3%-49.6%; n = 24 studies; I2 = 99%) for medical students, 55.8% (95% CI, 48.1%-63.6%; n = 37 studies; I2 = 96%) for residents, 68.5% (95% CI, 57.6%-79.5%; n = 10 studies; I2 = 86%) for practicing physicians, and 74.9% (95% CI, 63.2%-86.7%; n = 8 studies; I2 = 22%) for cardiologists. CONCLUSIONS AND RELEVANCE Physicians at all training levels had deficiencies in ECG interpretation, even after educational interventions. Improved education across the practice continuum appears warranted. Wide variation in outcomes could reflect real differences in training or skill or differences in assessment design.
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Affiliation(s)
- David A Cook
- Office of Applied Scholarship and Education Science and Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - So-Young Oh
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Martin V Pusic
- Department of Emergency Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
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Mabuza LH, Mntla PS. Generalist practitioners' self-rating and competence in electrocardiogram interpretation in South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e7. [PMID: 32896150 PMCID: PMC7479388 DOI: 10.4102/phcfm.v12i1.2421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background Electrocardiogram (ECG) is the only practical, non-invasive method of recording and analysing cardiac abnormalities. It enables a primary healthcare (PHC) clinician to detect cardiac and non-cardiac abnormalities, some potentially life-threatening. Their early detection could save a patient’s life. Aim The aim of this study was to evaluate the competence of generalist practitioners in ECG interpretation. Setting This study was conducted at the Annual Refresher Course, Council for Scientific and Industrial Research (CSIR), Pretoria. Methods A cross-sectional study was conducted amongst 93 generalist practitioners, using a self-administered questionnaire containing 20 ECG tracings, commonly encountered in PHC. The tracings were categorised into primary ECG parameters, ECG emergencies and common ECG abnormalities. Competence was determined by the generalist practitioner’s number of correctly interpreted ECG tracings. Data associations were computed using the Fisher’s exact test. Statistical significance was set at p ≤ 0.05. Results Correct heart rate calculation was achieved by 14/83 (16.9%), ECG rhythm by 7/83 (8.4%), acute antero-septal myocardial infarction (MI) by 29/83 (34.9%), atrial fibrillation by 19/83 (22.9%) and cute inferior MI by 22/83 (26.5%) generalist practitioners. No correlation was found between the practitioners’ number of years in practice and competence in ECG interpretation (p > 0.05). The total number of correct answers achieved by all practitioners was 274/1860 (14.7%). Conclusion The generalist practitioners had poor competency on ECG interpretation regardless of the number of years in practice. Their poor self-rating corresponded with the number of correct answers they provided. There is a need for continuous education in ECG interpretation.
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Affiliation(s)
- Langalibalele H Mabuza
- Department of Family Medicine and Primary Health Care, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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Interpretations of and management actions following ECGs in programmatic cardiovascular care in primary care: A retrospective dossier study. Neth Heart J 2020; 28:192-201. [PMID: 32077061 PMCID: PMC7113334 DOI: 10.1007/s12471-020-01376-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The usefulness of routine electrocardiograms (ECGs) in cardiovascular risk management (CVRM) and diabetes care is doubted. Objectives To assess the performance of general practitioners (GPs) in embedding ECGs in CVRM and diabetes care. Methods We collected 852 ECGs recorded by 20 GPs (12 practices) in the context of CVRM and diabetes care. Of all abnormal (n = 265) and a sample of the normal (n = 35) ECGs, data on the indications, interpretations and management actions were extracted from the corresponding medical records. An expert panel consisting of one cardiologist and one expert GP reviewed these 300 ECG cases. Results GPs found new abnormalities in 13.0% of all 852 ECGs (12.0% in routinely recorded ECGs versus 24.3% in ECGs performed for a specific indication). Management actions followed more often after ECGs performed for specific indications (17.6%) than after routine ECGs (6.0%). The expert panel agreed with the GPs’ interpretations in 67% of the 300 assessed cases. Most often misinterpreted relevant ECG abnormalities were previous myocardial infarction, R‑wave abnormalities and typical/atypical ST-segment and T‑wave (ST-T) abnormalities. Agreement on patient management between GP and expert panel was 74%. Disagreement in most cases concerned additional diagnostic testing. Conclusions In the context of programmatic CVRM and diabetes care by GPs, the yield of newly found ECG abnormalities is modest. It is higher for ECGs recorded for a specific reason. Educating GPs seems necessary in this field since they perform less well in interpreting and managing CVRM ECGs than in ECGs performed in symptomatic patients. Electronic supplementary material The online version of this article (10.1007/s12471-020-01376-3) contains supplementary material, which is available to authorized users.
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Verbiest-van Gurp N, van Mil D, van Kesteren HAM, Knottnerus JA, Stoffers HEJH. How do Dutch general practitioners detect and diagnose atrial fibrillation? Results of an online case vignette study. BMC FAMILY PRACTICE 2019; 20:175. [PMID: 31837709 PMCID: PMC6911277 DOI: 10.1186/s12875-019-1064-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022]
Abstract
Background Detection and treatment of atrial fibrillation (AF) are important given the serious health consequences. AF may be silent or paroxysmal and remain undetected. It is unclear whether general practitioners (GPs) have appropriate equipment and optimally utilise it to detect AF. This case vignette study aimed to describe current practice and to explore possible improvements to optimise AF detection. Methods Between June and July 2017, we performed an online case vignette study among Dutch GPs. We aimed at obtaining at least 75 responses to the questionnaire. We collected demographics and asked GPs’ opinion on their knowledge and experience in diagnosing AF. GPs could indicate which diagnostic tools they have for AF. In six case vignettes with varying symptom frequency and physical signs, they could make diagnostic choices. The last questions covered screening and actions after diagnosing AF. We compared the answers to the Dutch guideline for GPs on AF. Results Seventy-six GPs completed the questionnaire. Seventy-four GPs (97%) thought they have enough knowledge and 72 (95%) enough experience to diagnose AF. Seventy-four GPs (97%) could order or perform ECGs without the interference of a cardiologist. In case of frequent symptoms of AF, 36–40% would choose short-term (i.e. 24–48 h) and 11–19% long-term (i.e. 7 days, 14 days or 1 month) monitoring. In case of non-frequent symptoms, 29–31% would choose short-term and 21–30% long-term monitoring. If opportunistic screening in primary care proves to be effective, 83% (58/70) will support it. Conclusions Responding GPs report to have adequate equipment, knowledge, and experience to detect and diagnose AF. Almost all participants can order ECGs. Reported monitoring duration was shorter than recommended by the guideline. AF detection could improve by increasing the monitoring duration.
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Affiliation(s)
- N Verbiest-van Gurp
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Peter Debyeplein 1, 6229 HA, Maastricht, Limburg, The Netherlands.
| | - D van Mil
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Peter Debyeplein 1, 6229 HA, Maastricht, Limburg, The Netherlands
| | - H A M van Kesteren
- Department of Cardiology, Admiraal de Ruyter Ziekenhuis, 's-Gravenpolderseweg 114, 4462, RA Goes, Zeeland, The Netherlands
| | - J A Knottnerus
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Peter Debyeplein 1, 6229 HA, Maastricht, Limburg, The Netherlands
| | - H E J H Stoffers
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Peter Debyeplein 1, 6229 HA, Maastricht, Limburg, The Netherlands
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Wagenvoort LME, Willemsen RTA, Konings KTS, Stoffers HEJH. Interpretations of and management actions following electrocardiograms in symptomatic patients in primary care: a retrospective dossier study. Neth Heart J 2019; 27:498-505. [PMID: 31301001 PMCID: PMC6773798 DOI: 10.1007/s12471-019-01306-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The electrocardiogram (ECG) has become a popular tool in primary care. The clinical value of the ECG depends on the appropriateness of the indication and the interpretation skills of the general practitioner (GP). OBJECTIVES To describe the use of electrocardiography in primary care and to assess the performance of GPs in interpreting ECGs and making subsequent management decisions. METHODS Three hundred ECGs, recorded during daily practice in symptomatic patients by 14 GPs who regularly perform electrocardiography, were selected. Corresponding data of the indications, interpretations and subsequent management actions were extracted from the associated medical records. A panel consisting of an expert GP and a cardiologist reviewed the ECGs and specified their agreement with the findings and actions of the study GPs. RESULTS The most common indications were suspicion of a rhythm abnormality (43.7%), ischaemic heart disease (42.7%) and patient reassurance (14.3%). The study GPs interpreted 53.3% of the ECGs as showing no (new or acute) abnormality, whereas supraventricular rhythm disorders (12.3%), conduction disorders (7.7%) and repolarisation disorders (7.0%) were the most frequently reported pathological findings. Overall, the expert panel disagreed with the interpretations of the study GPs in 16.2% of cases, and with the GPs' management actions in 11.7%. Learning goals for GPs performing electrocardiography could be formulated for acute coronary syndrome, rhythm disorders, pulmonary embolism, reassurance, left ventricular hypertrophy and premature ventricular complexes. CONCLUSION GPs who feel competent in electrocardiography performed well in the opinion of the expert panel. We formulated various learning objectives for GPs performing electrocardiography.
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Affiliation(s)
- L M E Wagenvoort
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - R T A Willemsen
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.
| | - K T S Konings
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - H E J H Stoffers
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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