Failure to identify high-risk ECG findings in AMI patients was associated with significantly higher odds of not receiving reperfusion therapy (OR 7.69; 95% CI 3.57-16.67).
Cohort (n=1,684)
Yes
Does the failure to identify high-risk ECG findings reduce the receipt of evidence-based therapy in patients with acute myocardial infarction?
Failure to identify high-risk ECG findings in ED patients with AMI is associated with significantly lower rates of receiving guideline-directed therapies such as aspirin, beta-blockers, and reperfusion.
Effect estimate: OR 7.69 (95% CI 3.57 to 16.67)
BACKGROUND: The impact of misinterpretation of the ECG in patients with acute myocardial infarction (AMI) in the emergency department (ED) setting is not well known. Our goal was to assess the prevalence of the failure to identify high-risk ECG findings in ED patients with AMI and to determine whether this failure is associated with lower-quality care. METHODS AND RESULTS: In a retrospective cohort study of consecutive patients presenting to 5 EDs in California and Colorado from July 1, 2000, through June 30, 2002, with confirmed AMI (n=1684), we determined the frequency of the failure by the treating provider to identify significant ST-segment depressions, ST-segment elevations, or T-wave inversions on the presenting ECG. In multivariable models, we assessed the relationship between missed high-risk ECG findings and evidence-based therapy in the ED after adjustment for patient characteristics and site of care. High-risk ECG findings were not documented in 201 patients (12%). The failure to identify high-risk findings was independently associated with a higher odds of not receiving treatment among ideal candidates for aspirin (odds ratio OR, 2.13; 95% confidence interval CI, 1.51 to 2.94), beta-blockers (OR, 1.85; 95% CI, 1.14 to 3.03), and reperfusion therapy (OR, 7.69; 95% CI, 3.57 to 16.67). Among patients with missed high-risk ECG findings, in-hospital mortality was 7.9% compared with 4.9% among those without missed findings (P=0.1). CONCLUSIONS: The failure to identify high-risk ECG findings in patients with AMI results in lower-quality care in the ED. Systematic processes to improve ECG interpretation may have important implications for patient treatment and outcomes.
Masoudi et al. (2006) conducted a cohort in acute myocardial infarction (n=1,684). Failure to identify high-risk ECG findings vs. Identification of high-risk ECG findings was evaluated on not receiving reperfusion therapy among ideal candidates (OR 7.69, 95% CI 3.57 to 16.67). Failure to identify high-risk ECG findings in AMI patients was associated with significantly higher odds of not receiving reperfusion therapy (OR 7.69; 95% CI 3.57-16.67).