Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Aug;49(2):236-43.e2.
doi: 10.1016/j.jemermed.2015.02.013. Epub 2015 May 2.

Emergency Physicians' Perceptions and Decision-making Processes Regarding Patients Presenting with Palpitations

Marc A Probst  1 , Hemal K Kanzaria  2 , Jerome R Hoffman  3 , William R Mower  3 , Roya S Moheimani  3 , Benjamin C Sun  4 , Denise D Quigley  5
Affiliations

Emergency Physicians' Perceptions and Decision-making Processes Regarding Patients Presenting with Palpitations

Marc A Probst et al. J Emerg Med. 2015 Aug.

Abstract

Background: Palpitations are a common emergency department (ED) complaint, yet relatively little research exists on this topic from an emergency care perspective.

Objectives: We sought to describe the perceptions and clinical decision-making processes of emergency physicians (EP) surrounding patients with palpitations.

Methods: We conducted 21 semistructured interviews with a convenience sample of EPs. We recruited participants from academic and community practice settings from four regions of the United States. The transcribed interviews were analyzed using a combination of structural coding and grounded theory approaches with ATLAS.ti, a qualitative data analysis software program (version 7; Atlas.ti Scientific Software Development GmbH, Berlin, Germany).

Results: EPs perceive palpitations to be a common but generally benign chief complaint. EPs' clinical approach to palpitations, with regards to testing, treatment, and ED management, can be classified as relating to one or more of the following themes: (1) risk stratification, (2) diagnostic categorization, (3) algorithmic management, and (4) case-specific gestalt. With regard to disposition decisions, four main themes emerged: (1) presence of a serious diagnosis, (2) perceived need for further cardiac testing/monitoring, (3) presence of key associated symptoms, (4) request of other physician or patient desire. The interrater reliability exercise yielded a Fleiss' kappa measure of 0.69, indicating substantial agreement between coders.

Conclusion: EPs perceive palpitations to be a common but generally benign chief complaint. EPs rely on one or more of four main clinical approaches to manage these patients. These findings could help guide future efforts at developing risk-stratification tools and clinical algorithms for patients with palpitations.

Keywords: clinical decision-making; emergency medicine; interviews; palpitations.

PubMed Disclaimer

Conflict of interest statement

Disclosures:

There are no other conflicts of interest.

References

    1. Probst MA, Mower WR, Kanzaria HK, et al. Analysis of Emergency Department Visits for Palpitations (from the National Hospital Ambulatory Medical Care Survey) Am J Cardiol. 2014;113(10):1685–1690. - PMC - PubMed
    1. Weber BE, Kapoor WN. Evaluation and outcomes of patients with palpitations. Am J Med. 1996:138–148. - PubMed
    1. Jamshed N, Dubin J, Eldadah Z. Emergency management of palpitations in the elderly: epidemiology, diagnostic approaches, and therapeutic options. Clin Geriatr Med. 2013;29(1):205–230. - PubMed
    1. Kinlay S, Leitch JW, Neil A, et al. Cardiac event recorders yield more diagnoses and are more cost-effective than 48-hour Holter monitoring in patients with palpitations. A controlled clinical trial. Ann Intern Med. 1996;124(1 Pt 1):16–20. - PubMed
    1. Thavendiranathan P, Bagai A, Khoo C, et al. Does this patient with palpitations have a cardiac arrhythmia? JAMA. 2009:2135–2143. - PubMed