Interpretations of and management actions following electrocardiograms in symptomatic patients in primary care: a retrospective dossier study

Figures

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  Fig. 1. Participating practices, general practitioners (GPs) and collection of electrocardiograms (ECGs). We included ECGs that had been recorded and interpreted by the GPs during office hours in symptomatic patients, i.e. after a complaint reported to the GP or a finding observed during physical examination. Routinely performed ECGs for screening purposes were excluded

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  Fig. 2. Percentage of presenting symptoms and signs in patients in whom the GP recorded an ECG, as reported in the medical records (n = 300). More than one symptom or sign may have been mentioned per ECG. ‘Other (n = 7)’ included: heart enlargement on chest radiography, biliary colic pain, panic attack, electrolyte abnormality, undefined, neurological deficit (2 ×) (ECG electrocardiogram, GP general practitioner)

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  Fig. 3. Indications for ECGs by GPs (percentage of all ECGs, n = 300). Since occasionally more than one indication was reported, the total number of reported indications (n = 385) exceeds the number of ECGs (n = 300). ‘Other (n = 6)’ included: myocarditis, pericarditis, hyperkalaemia, suspected long QT interval, aneurysm of abdominal aorta, no indication. All mentioned once (ECG electrocardiogram, GP general practitioner)

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  Fig. 4. Absolute numbers of ECG abnormalities missed or incorrectly interpreted by GPs. In 43 out of 300 ECGs, 60 missed or incorrectly interpreted ECG abnormalities were described by the expert panel. ‘Other (n = 11)’ included: sinus bradycardia, supraventricular premature complex, atrial flutter, non-sustained ventricular tachycardia, 1st degree AV block, 3rd degree AV block, right axis deviation, horizontal axis, ‘pathological’ Q‑wave, S1Q3 pattern, lead reversal. All mentioned once (AV atrioventricular, ECG electrocardiogram, GP general practitioner, LV left ventricular, RV right ventricular)