Electrocardiogram interpretation in general practice
-
Upload
wilma-hansen -
Category
Documents
-
view
29 -
download
0
description
Transcript of Electrocardiogram interpretation in general practice
![Page 1: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/1.jpg)
Electrocardiogram interpretation in general practice
![Page 2: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/2.jpg)
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
![Page 3: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/3.jpg)
Objectives To know the sensitivity and the
specificity of ECG interpretation by both GPs and interpretative recorders.
![Page 4: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/4.jpg)
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
![Page 5: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/5.jpg)
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.
![Page 6: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/6.jpg)
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)
![Page 7: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/7.jpg)
Results abnormal ECGM+
(cardio)
M-
cardio
M+
(GP)
182
M-
(GP)
720
96 806 902
![Page 8: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/8.jpg)
Results abnormal ECG If the sensitivity = 69.8%
![Page 9: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/9.jpg)
Results abnormal ECGM+
(cardio)
M-
(cardio)
M+
(MG)
67 115 182
M-
(MG)
29 691 720
96 806 902
![Page 10: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/10.jpg)
Results abnormal ECGGP ECG recorder
Sensibility
(p<0.001)
69.8% 84.4%
Spécificity (p<0.001)
85.7% 75.6%
PPV 36.8% 29.1%
PNV 96% 97.6%
![Page 11: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/11.jpg)
Results ischaemia or myocardial infarction
GP ECG recorder
Sensibility
(p<0.001)
22.6% 64.5%
Specificity
(p<0.001)
94.1% 84.5%
PPV 12.1% 12.9%
PNV 97.2% 98.5%
![Page 12: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/12.jpg)
Results any bundle branch
Sensitivity and specificity: no significant difference
![Page 13: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/13.jpg)
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
![Page 14: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/14.jpg)
Conclusions PPV: low PNV: high Low prevalence of abnormal ECG in
this population
![Page 15: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/15.jpg)
Positive point GPs never knew that their ECG
interpretation skills will be evaluated real skills of the GPs
![Page 16: Electrocardiogram interpretation in general practice](https://reader035.fdocuments.net/reader035/viewer/2022072014/56812d88550346895d929ba8/html5/thumbnails/16.jpg)
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?