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Electrocardiography in primary care; is it useful?
F H Rutten1, A G Kessels, F F Willems
1Julius Center for General Practice and Patient-Oriented Research, University Medical Center Utrecht, P.O. Box 80045, 3508 TA Utrecht, The Netherlands. f.h.rutten@med.uu.nl
International Journal of Cardiology
|August 30, 2000
Summary
Electrocardiography (ECG) in primary care significantly alters general practitioner management for suspected cardiovascular issues. This diagnostic tool aids in reducing unnecessary referrals and guides cardiovascular therapy decisions.
Area of Science:
- Cardiology
- Primary Care Medicine
- Diagnostic Tools
Background:
- The clinical utility of electrocardiography (ECG) in primary care settings remains underexplored.
- General practitioners (GPs) often manage patients presenting with symptoms suggestive of cardiovascular disease.
Purpose of the Study:
- To evaluate if electrocardiography (ECG) provides additional value beyond standard history taking and physical examination.
- To determine if ECG influences GP management decisions for patients with potential cardiovascular conditions.
Main Methods:
- Prospective study involving eight general practices over two years.
- Collected data on 301 ECGs, including indications, GP management before and after ECG, and subjective usefulness.
- Clinical information and 6-month follow-up were reviewed by GPs and a cardiologist.
Main Results:
- ECG results led to a change in management for 30.6% of patients.
- Changes included reduced referrals, initiated referrals, and modified cardiovascular therapy.
- In chest pain patients, ECG findings effectively differentiated likelihood of cardiac events (LR 0.06 for normal, 13.3 for abnormal).
Conclusions:
- Electrocardiography (ECG) is a valuable tool in primary care, complementing clinical assessment.
- ECG can significantly decrease the rate of inappropriate referrals to specialists.
- The subjective usefulness of ECG by GPs was rated highly (mean 77.5).