What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Geriatric inpatients (n=226). Intervention: 12-lead Electrocardiogram (ECG). Primary outcome: Proportion of ECGs performed, documented, and containing abnormalities.

What question did this study set out to answer?

The aim is to examine ECG practices and prevalence of abnormalities among elderly patients at risk for Atrial Fibrillation and stroke.

March 28, 2026BMC Geriatrics0 citationsOpen Access

ECG practices in a geriatric population within a quaternary hospital: a cross-sectional analysis

SMS. MahendranThe University of Sydney KSKasun De SilvaElectrophysiology ABAshwin BhaskaranThe University of Sydney

Key Result

Among 226 hospitalized patients aged ≥75 years, 92.5% had an ECG performed, yet only 49% were signed by a clinician despite 76% of reviewed ECGs containing abnormalities.

Key Points

The aim is to examine ECG practices and prevalence of abnormalities among elderly patients at risk for Atrial Fibrillation and stroke.
Cross-sectional analysis of patients aged ≥75 admitted to a quaternary hospital.
Data extraction from electronic medical records including ECG records and demographics.
ECGs reviewed by two Cardiologists, discrepancies resolved by a third Cardiologist.
Assessment according to AHA/ACC recommendations.
92.5% of patients had an ECG performed during admission.
Only 54.1% of ECG findings were reported in clinical documentation.
Of ECGs reviewed, 91.9% were deemed technically adequate, but only 15.3% were normal.
Most common findings included conduction disease (40.8%), arrhythmia (37.8%), and ischaemia (10.5%).
31.8% of patients had known AF, with gaps in anticoagulation treatment.

Study Design

Type

Cross-Sectional (n=226)

Multicenter

Structured PICO

Population

Inpatients aged ≥75 years admitted to a quaternary hospital, mean age 82.97, 49.56% female

Outcome

Prevalence of potentially clinically significant ECG findings and current ECG reporting practices

There is a high burden of clinically significant ECG abnormalities in hospitalized geriatric patients, yet significant gaps exist in formal ECG reporting and guideline-directed anticoagulation for atrial fibrillation.

Limitations

Single-center study
Cross-sectional point-prevalence design
Retrospective review of electronic medical records

Abstract

Electrocardiograms (ECGs) are commonly performed in hospitals as part of clinical assessment and could be an opportunity to detect other incidental health conditions. This study aims to examine ECG practices among elderly patients at high risk of Atrial Fibrillation (AF) and stroke within a quaternary hospital setting and the prevalence of potentially clinically significant findings. Cross-sectional analysis of all patients ≥75 years admitted to a large quaternary hospital. Data extracted from the electronic medical record included patient demographics, comorbidities, reason for presentation, and ECG records. Each ECG was reviewed by two Cardiologists, with discrepancies resolved by a third Cardiologist. ECGs were assessed according to American Heart Association/American College of Cardiology (AHA/ACC) recommendations. Of 226 patients, age 82.97±6.16, F = 112 (49.56%), 92.5% (209/226) patients had an ECG performed during their admission. Among the 209 ECGs, interpretation of findings was only reported in clinical documentation for 113 (54.1%). Of the 198/209 ECGs able to be retrieved for review, only 97 (49.0%) had been signed by a clinician as being sighted. The 198 ECGs analysed independently by two Cardiologists, resulted in 396 ECG reviews, of which 364 (91.9%), were considered technically adequate and only 30 ECGs (15.3%) were assessed as normal by both reviewers. The most common abnormalities were conduction disease (160/392 ; 40.8%), arrhythmia (148/392; 37.8%) and ischaemia (41/392; 10.5%). 72 (31.8%) patients in this study had known AF, of whom 14 (19.4%) were not anticoagulated and 8 (11.1%) were not on the guideline-recommended dose of anticoagulation. This study highlights the burden of ECG abnormalities and a gap in the treatment of AF in elderly patients. There is opportunity to improve detection and facilitate earlier management of AF and other clinically significant ECG findings through a more robust ECG reporting system.

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