Evaluation of general practitioners' single-lead electrocardiogram interpretation skills: a case-vignette study.
Fam Pract
; 38(2): 70-75, 2021 03 29.
Article
em En
| MEDLINE
| ID: mdl-32766703
ABSTRACT
BACKGROUND:
Handheld single-lead electrocardiograms (1L-ECG) present a welcome addition to the diagnostic arsenal of general practitioners (GPs). However, little is known about GPs' 1L-ECG interpretation skills, and thus its reliability in real-world practice.OBJECTIVE:
To determine the diagnostic accuracy of GPs in diagnosing atrial fibrillation or flutter (AF/Afl) based on 1L-ECGs, with and without the aid of automatic algorithm interpretation, as well as other relevant ECG abnormalities.METHODS:
We invited 2239 Dutch GPs for an online case-vignette study. GPs were asked to interpret four 1L-ECGs, randomly drawn from a pool of 80 case-vignettes. These vignettes were obtained from a primary care study that used smartphone-operated 1L-ECG recordings using the AliveCor KardiaMobile. Interpretation of all 1L-ECGs by a panel of cardiologists was used as reference standard.RESULTS:
A total of 457 (20.4%) GPs responded and interpreted a total of 1613 1L-ECGs. Sensitivity and specificity for AF/Afl (prevalence 13%) were 92.5% (95% CI 82.5-97.0%) and 89.8% (95% CI 85.5-92.9%), respectively. PPV and NPV for AF/Afl were 45.7% (95% CI 22.4-70.9%) and 98.8% (95% CI 97.1-99.5%), respectively. GP interpretation skills did not improve in case-vignettes where the outcome of automatic AF-detection algorithm was provided. In detecting any relevant ECG abnormality (prevalence 22%), sensitivity, specificity, PPV and NPV were 96.3% (95% CI 92.8-98.2%), 68.8% (95% CI 62.4-74.6%), 43.9% (95% CI 27.7-61.5%) and 97.9% (95% CI 94.9-99.1%), respectively.CONCLUSIONS:
GPs can safely rule out cardiac arrhythmias with 1L-ECGs. However, whenever an abnormality is suspected, confirmation by an expert-reader is warranted.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
/
Clínicos Gerais
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article