Frequency and Patterns of Electrocardiogram Testing among High-risk Elderly Individuals

Electrocardiogram (ECG) may detect atrial fibrillation (AF), but the true rate of ECG performance is unknown.

To explore the performance rate of ECG testing in patient populations at high risk for AF in a real-world cohort and to explore the incidence of newly diagnosed AF.

This retrospective observational cohort study included de-identified data of members of Maccabi Health Services older than 65 years, excluding patients with prior AF and other cardiac diseases. Patients were followed between 1 January 2016 and 30 September 2020. The number of ECGs performed in an outpatient setting for each patient was reported.

In total, 211,515 patients (59.8% female) were included. The mean age was 70.3 ± 6.6 years, with a mean CHA2DS2-VASc score of 2.6 ± 1.0. During the study period, over half of the patients (n=112,340; 53.1%) did not undergo any ECG tests, 51,644 patients (24.4%) had one ECG, 24,914 patients (11.8%) had two, while 22,617 patients (10.7%) had more than three. Of the patients referred for an ECG, 67,433 (81.1%) underwent ECG testing within 2 months following the referral. The median time from ECG referral to ECG testing was 5 days.

Most patients older than 65 years had no ECG tests within a 5-year period. However, when referred to an ECG test, most patients complied within a median of 5 days.