Electrocardiogram as a screening tool to exclude chronic systolic heart failure with reduced left ventricular...

Area of Science:

• Cardiology
• Medical Diagnostics
• Primary Care Medicine

Background:

• Increasing wait times for echocardiography impact timely diagnosis of de novo systolic heart failure (HF).
• Screening tools are needed to identify patients with HF, particularly those with reduced left ventricle ejection fraction (LVEF).
• Electrocardiogram (ECG) is a potential non-invasive screening method.

Purpose of the Study:

• To assess the diagnostic value of ECG in identifying HF with reduced LVEF in primary care referrals.
• To compare the diagnostic accuracy of automatic ECG interpretation with cardiologist interpretation.
• To evaluate the utility of ECG as a gatekeeping tool for HF diagnosis.

Main Methods:

• Retrospective observational study (2020-2021) of 248 patients referred from primary care for suspected HF.
• All patients underwent ECG prior to echocardiography for LVEF assessment.
• Analysis included diagnostic value, negative predictive value, and impact on risk prediction models.

Main Results:

• 61.5% of patients had an abnormal ECG; 7.7% had LVEF ≤ 40%.
• Abnormal ECG was significantly associated with reduced LVEF.
• The negative predictive value of ECG was 99%, irrespective of interpretation method (cardiologist vs. automatic).
• ECG improved a logistic risk model's area under the curve from 0.72 to 0.79.

Conclusions:

• Normal ECG can safely exclude HF with LVEF < 50%.
• ECG serves as an effective gatekeeping tool for primary care physicians managing suspected de novo systolic HF.
• This study is the first to compare automatic vs. cardiologist ECG interpretation for HF screening.