Erroneous computer-based interpretations of atrial fibrillation and atrial flutter in a Swedish primary health care setting

Objective: To describe the incidence of incorrect computerized ECG interpretations of atrial fibrillation or atrial flutter in a Swedish primary care population, the rate of correction of computer misinterpretations, and the consequences of misdiagnosis.Design: Retrospective expert re-analysis of ECGs with a computer-suggested diagnosis of atrial fibrillation or atrial flutter.Setting: Primary health care in Region Kronoberg, Sweden.Subjects: All adult patients who had an ECG recorded between January 2016 and June 2016 with a computer statement including the words ‘atrial fibrillation’ or ‘atrial flutter’.Main outcome measures: Number of incorrect computer interpretations of atrial fibrillation or atrial flutter; rate of correction by the interpreting primary care physician; consequences of misdiagnosis of atrial fibrillation or atrial flutter.Results: Among 988 ECGs with a computer diagnosis of atrial fibrillation or atrial flutter, 89 (9.0%) were incorrect, among which 36 were not corrected by the interpreting physician. In 12 cases, misdiagnosed atrial fibrillation/flutter led to inappropriate treatment with anticoagulant therapy. A larger proportion of atrial flutters, 27 out of 80 (34%), than atrial fibrillations, 62 out of 908 (7%), were incorrectly diagnosed by the computer.Conclusions: Among ECGs with a computer-based diagnosis of atrial fibrillation or atrial flutter, the diagnosis was incorrect in almost 10%. In almost half of the cases, the misdiagnosis was not corrected by the overreading primary-care physician. Twelve patients received inappropriate anticoagulant treatment as a result of misdiagnosis.Key pointsData regarding the incidence of misdiagnosed atrial fibrillation or atrial flutter in primary care are lacking. In a Swedish primary care setting, computer-based ECG interpretations of atrial fibrillation or atrial flutter were incorrect in 89 of 988 (9.0%) consecutive cases.Incorrect computer diagnoses of atrial fibrillation or atrial flutter were not corrected by the primary-care physician in 47% of cases.In 12 of the cases with an incorrect computer rhythm diagnosis, misdiagnosed atrial fibrillation or flutter led to inappropriate treatment with anticoagulant therapy.