Frequency and Patterns of Electrocardiogram Testing among High-risk Elderly Individuals
Arthur Shiyovich1, Gil Marcus2, Rola Hamood3
1Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
The Israel Medical Association Journal : IMAJ
|August 6, 2026
Summary
Most older adults did not receive electrocardiogram (ECG) tests for atrial fibrillation (AF) screening within a 5-year period. However, compliance with ECG testing referrals was high, with a median of 5 days for completion.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Electrocardiogram (ECG) is crucial for detecting atrial fibrillation (AF).
- The actual rate of ECG performance in high-risk populations remains unclear.
- Understanding ECG utilization is vital for improving AF screening strategies.
Purpose of the Study:
- To determine the rate of ECG testing in patients over 65 at high risk for AF.
- To assess the incidence of newly diagnosed AF in this cohort.
- To evaluate ECG performance rates in a real-world healthcare setting.
Main Methods:
- Retrospective observational cohort study of de-identified health data.
- Included over 211,000 patients aged 65+ without prior AF or cardiac conditions.
- Followed patients from January 2016 to September 2020, analyzing outpatient ECG performance.
Main Results:
- Over half (53.1%) of patients received no ECGs during the study period.
- Only 10.7% of patients underwent more than three ECG tests.
- For referred patients, 81.1% had ECG testing within 2 months, with a median time of 5 days.
Conclusions:
- A significant proportion of elderly patients did not undergo ECG screening for AF over 5 years.
- Prompt patient compliance with ECG referrals was observed.
- The findings highlight potential gaps in routine AF screening protocols for older adults.
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