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- Title
Evaluation of general practitioners' single-lead electrocardiogram interpretation skills: a case-vignette study.
- Authors
Karregat, Evert P M; Himmelreich, Jelle C L; Lucassen, Wim A M; Busschers, Wim B; Weert, Henk C P M van; Harskamp, Ralf E; van Weert, Henk C P M
- Abstract
<bold>Background: </bold>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.<bold>Objective: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>GPs can safely rule out cardiac arrhythmias with 1L-ECGs. However, whenever an abnormality is suspected, confirmation by an expert-reader is warranted.
- Subjects
GENERAL practitioners; ARRHYTHMIA; ATRIAL fibrillation; ELECTROCARDIOGRAPHY; ATRIAL flutter; ATRIAL fibrillation diagnosis; RESEARCH; RESEARCH evaluation; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies
- Publication
Family Practice, 2021, Vol 38, Issue 2, p70
- ISSN
0263-2136
- Publication type
journal article
- DOI
10.1093/fampra/cmaa076