Electrocardiogram interpretation and arrhythmia management: a primary and secondary care survey

Abstract

Background: There is increasing desire among service commissioners to treat arrhythmia in primary care. Accurate interpretation of the electrocardiogram (ECG) is fundamental to this. ECG interpretation has previously been shown to vary widely but there is little recent data.

Aim: To examine the interpretation of ECGs in primary and secondary care.

Design and setting: A cross-sectional survey of participants' interpretation of six ECGs and hypothetical management of patients based on those ECGs, at primary care educational events, and a cardiology department in Leeds.

Method: A total of 262 primary care clinicians and 20 cardiology clinicians were surveyed via questionnaire. Answers were compared with expert electrophysiologist opinion.

Results: In primary care, abnormal ECGs were interpreted as normal by 23% of responders. ST elevation and prolonged QT were incorrectly interpreted as normal by 1% and 22%, respectively. In cardiology, abnormal ECGs were interpreted as normal by 3%.

Conclusion: ECG provision and interpretation remains inconsistent in both primary and secondary care. Primary care practitioners are less experienced and less confident with ECG interpretation than cardiologists, and require support in this area.

Keywords: cardiac arrhythmias; cardiology; electrocardiography; general practice; questionnaires.

Figure 1.

ECG findings and patient presentations. ECG 1: Left axis deviation, single atrial ectopic beat. ’40-year-old female with flutters.’ ECG 2: ST elevation. ’55-year-old male, syncope at the gym’ (RED FLAG). ECG 3: Atrial fibrillation. ’75-year-old female, diabetic, no symptoms.’ ECG 4: Normal ECG. ‘50-year-old female, sudden onset and offset regular palpitations.’ ECG 5: Prolonged QT interval. ’16-year-old female, blackout in school assembly’ (RED FLAG). ECG 6: Poor-quality ECG, sinus rhythm, erroneous automated report of AF. ’81-year-old female, breathless.’