An algorithm to assist novices with electrocardiogram interpretation: Validation with the Delphi Method.

PURPOSE: Electrocardiograms (ECG) are often poorly interpreted by novices and this can delay time-sensitive, critical intervention. This study aimed to assess, improve and validate a stepwise ECG algorithm designed to assist with ECG interpretation by novices by soliciting the opinions of an international cohort of expert cardiologists. METHODS: The Delphi Method was used, and an online questionnaire was sent to an international panel of cardiologists. Experts were required to evaluate each step of the algorithm and offer comments. Feedback was analysed by the investigators, changes to the algorithm were made and these were sent back to the experts until a consensus was reached. Two rounds of the Delphi Method were required to achieve consensus. RESULTS: Overall, 55 responses were achieved (round one = 33, round two = 22). The average agreement in round one was 90.2% with 25 changes from 124 comments. Round two achieved 93.4% agreement with 12 changes from 57 comments. The threshold for consensus was set at 90% and was confirmed as being reached by all four investigators of this study. A final algorithm was therefore established. The ECG algorithm was validated through a rigorous two-stage development and review process. CONCLUSIONS: The algorithm was validated as a safe, informative tool for novices to use to improve ECG interpretation. Real-world user validation is now required to further improve the algorithm.

Disparity in implantable cardioverter defibrillator therapy among minority South Asians in the United Kingdom.

OBJECTIVE: There are large geographical differences in implantable cardioverter defibrillator (ICD) implantation rates for reasons not completely understood. In an increasingly multiethnic population, we sought out to investigate whether ethnicity influenced ICD implantation rates. METHODS: This was a retrospective, cohort study of new ICD implantation or upgrade to ICD from January 2006 to February 2019 in recipients of Caucasian or South Asian ethnicity at a single tertiary centre in the UK. Data were obtained from a routinely collected local registry. Crude rates of ICD implantation were calculated for the population of Leicestershire county and were age-standardised to the UK population using the UK National Census of 2011. RESULTS: The Leicestershire population was 980 328 at the time of the Census, of which 761 403 (77.7%) were Caucasian and 155 500 (15.9%) were South Asian. Overall, 2650 ICD implantations were performed in Caucasian (91.9%) and South Asian (8.1%) patients. South Asians were less likely than Caucasians to receive an ICD (risk ratio (RR) 0.43, 95% CI 0.37 to 0.49, p<0.001) even when standardised for age (RR 0.75, 95% CI 0.74 to 0.75, p<0.001). This remained the case for primary prevention indication (age-standardised RR 0.91, 95% CI 0.90 to 0.91, p<0.001), while differences in secondary prevention ICD implants were even greater (age-standardised RR 0.49, 95% CI 0.48 to 0.50, p<0.001). CONCLUSION: Despite a universal and free healthcare system, ICD implantation rates were significantly lower in the South Asian than the Caucasian population residing in the UK. Whether this is due to cultural acceptance or an unbalanced consideration is unclear.