Diagnosis of right bundle branch block: a concordance study.

BACKGROUND: Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist. METHODS: The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy. RESULTS: We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers. CONCLUSION: The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.

[Prevalence and incidence of electrocardiographic abnormalities in healthy population older than 49]. / Prevalencia e incidencia de las alteraciones electrocardiográficas en población general sana mayor de 49 años.

PURPOSE: To determine the prevalence and incidence of electrocardiographic abnormalities (EKG-abn). MATERIAL AND METHODS: Design. 2 stage study: 1st: descriptive cross-sectional, 2nd: prospective cohort. LOCATION: 28 urban primary health centers in Barcelona city area. PARTICIPANTS: The study population was composed by patients who had participated in the population based ARTPER multicentric study. This study has two phases where each patient had one EKG, physical examination and blood test to obtain the secondary variables. The available EKG from both phases were reviewed, achieving a total of 2,727 patients with EKG. 601 (22%) individuals with CV disease were excluded. A total of 2.126 patients were studied of whom 392 (18%) had 2 EKG, one at each phase. Mean measurements. The association between the presence of EKG-abn and explanatory variables was performed using multivariate logistic regression, obtaining odds ratios (OR) and their 95% confidence intervals (95%CI). RESULTS: 58% women and average age 66years. 32% (95%CI: 30%-34%) (n=671) presented EKG-abn of whom 60% (n=402) were minor and 40% (n=269) major disorders. The most common EKG-abn were the conduction disturbances. EKG-abn were associated with males (OR: 1.7; 95%CI: 1.4-2.1) and patients older than 65 (OR: 1.6; 95%CI: 1.4-2.0). Among the 345 people without EKG-abn at baseline and with 2 available EKG, 71 showed an EKG-abn at the second EKG (incidence in 4.7years of 21% (95%CI: 16%-25%). CONCLUSION: EKG abnormalities are common in healthy general population. EKG-abn are more common in male and elderly patients.

[Self care and risk factors of diabetic foot in patients with type II diabetes mellitus]. / Autocuidado y factores de riesgo de pie diabético en pacientes con diabetes mellitus tipo II.

OBJECTIVES: To find the amount of self-care (SC), health education (HE) received and the prevalence of risk factors for diabetic foot (RFDF) in patients with type II Diabetes Mellitus (DM) attended in Primary Care. DESIGN: A descriptive crossover study. SETTING: Primary Care Centre. PATIENTS: 100 DM patients attending over 2 months (May and June 1995) to see the doctor or collect prescriptions. MEASUREMENTS AND MAIN RESULTS: Questionnaire on HE, SC habits and social and demographic data, inspection of the feet and physical investigation of lower extremities. 36% had deficient or very deficient hygiene; 73% did not go regularly to the chiropodist, 76% used scissors, 75% did not check the inside of the shoe. 38% had signs of neuropathy and 17%, of peripheric vasculopathy. 25% were at high risk of diabetic foot. Women had more RFDF. CONCLUSIONS: The amount of self-care is very low, especially in hygiene, which did not improve over time. HE on foot care is extremely poor despite its being a priority. Educational interventions are required to motivate healthworkers and patients, especially those with most RFDF, in the area of SC.