Follow-up of patients after routine electrocardiogram testing in primary care

Abstract

FOLLOW-UP OF PATIENTS AFTER ROUTINE ELECTROCARDIOGRAM TESTING IN PRIMARY CARE Background: Electrocardiography (ECG) is commonly used in primary care to study and follow patients with cardiovascular di- seases. Aim: The purpose of this study was to assess changes in patient care after performance of an ECG during a primary care office visit. Methods: A prospective observational study was conducted at S. João Health Center, Oporto of all patients for whom an ECG was requested at primary care office visits over a two-year period, from 1/03/2007. Each time an ECG was requested, doctors recorded the reason for the test, the patient's symptoms, and past medical history. Electrocardiograms were saved for later ana- lysis. Clinical files were hand searched six months after the ECG to assess changes in patient care. A multinomial logistic regres- sion model was used to test associations between results of the ECG, classified by Novacode, and the indications for the test. Results: We studied 870 ECG, from 817 patients (56,4% females) with a median age of 57 years. The main reason for requesting an ECG was the presence of symptoms (48,5%). Analysis of the results of the ECG showed that 54,5% were interpreted as nor- mal, 35,9% had minor abnormalities, and 9,7% showed major abnormalities. Care of the patient remained unchanged after 67,9% of tests (CI95%: 64,8-70,0%), and referral for hospital care occurred after 5,7% (CI95%: 4,8-7,5%). In multivariate analysis, the decision to change patient care was significantly influenced by ECG results in patients in whom the test was requested for fol- low-up of known cardiovascular disease but not for those who reported symptoms at office visit. Conclusion: The ECG does not change the care of most patients who have the test done at an office visit. The greatest utility of the test was seen among patients with known cardiovascular risk factors or a past history of cardiovascular disease.