Accuracy of general practitioners’ readings of ECG in primary care

• Published in: Central European journal of medicine 2014-06, Vol.9 (3), p.431-436
• Main Authors: Santos, Paulo, Pessanha, Paulo, Viana, Manuel, Campelo, Manuel, Nunes, José Pedro, Hespanhol, Alberto Pinto, Macedo, Filipe, Couto, Luciana
• Format: Article
• Language: English
• Subjects: Biomedicine; Cardiovascular Disorders / Hypertension / DVT / Atherosclerosis; Continuing Medical Education; Diagnostic Tests; Graduate Medical Education / Fellowship Training; Internal Medicine; Maternal and Child Health; Measurement/ Psychometric Analyses; Medicine; Medicine & Public Health; Observational Research; Physician Competency Primary Care; Quality of Care; Reproductive Medicine; Research Article; Surgery
• ISSN: 1895-1058; 2391-5463; 1644-3640; 2391-5463
• DOI: 10.2478/s11536-013-0288-9

Background The electrocardiogram (ECG) is a diagnostic test commonly used in daily Primary Care practice. General Practitioners (GP) often feel unsure about their interpretation of ECGs, so they engage external services to provide it. Aim To evaluate accuracy of ECG readings done by GPs by comparison with those done by a cardiologist as the gold standard. Methods We studied 195 ECGs collected consecutively during first semester of 2010 in an urban Health Centre of Portugal. Each ECG was read by each physician and inter-observer agreement was evaluated. After coding by Novacode, sensitivity and specificity of GP’s readings were calculated. Results Inter-observer agreement between GP readings was “good” with an intraclass correlation coefficient of 0.727 (CI 95%: 0.670–0.779). When compared with gold standard, GP achieved a “good” agreement with an intraclass correlation coefficient of 0.712 (CI 95%: 0.659–0.762). The overall accuracy of GP for detecting abnormalities was 81.0% (95%CI: 75.7–85.6%), with a sensitivity of 84.8% (95%CI: 77.3–90.6%) and a specificity of 77.5% (95%CI: 69.7–84.2%). For normal tests, accuracy was 79.9% (95%CI: 74.7–84.3). In the most prevalent classes of abnormalities, accuracy was higher than 90%. Conclusion GP showed good skills in reading ECGs in their practice of Primary Care. Better attention should be given to ischemic abnormalities present on ECGs. Key message: General Practitioners demonstrate good skills for reading the ECGs of patients on a primary care centre when compared to the gold standard defined by a cardiologist reading.