Comparison of electrocardiogram interpretations by family physicians, a computer, and a cardiology service.

BACKGROUND

Some family physicians may be under pressure to relinquish the interpretation of outpatient electrocardiograms to cardiologists. The purpose of this study was to determine whether the quality of electrocardiogram (ECG) interpretations by family physicians justifies this pressure, and whether an immediately available computerized ECG interpretation program could serve as an appropriate backup for the family physician.

METHODS

Family practice faculty and residents at a university-based residency program provided written interpretations of 301 ECGs ordered over an 11-month period. Their ECG findings were compared with those from a computerized interpretation program and the readings of the cardiology service. All interpretations were then compared with those of a fellowship-trained electrocardiographer, whose readings served as the reference standard.

RESULTS

Discrepancy was found between the family physician and the electrocardiographer on 33% of those items that had any potential clinical significance. The computer interpretation and the cardiologist's interpretation agreed with that of the electrocardiographer on 63% and 71% of these discrepancies, respectively (not statistically different).

CONCLUSIONS

Family physicians reached a level of agreement with the reference standard in ECG interpretation that was comparable to previously published reports for expert interrater agreement. In this study, however, the quality of ECG readings by family physicians was further improved by expert review. The quality of computer-assisted ECG interpretation was comparable to that of review provided by a cardiology service. Furthermore, computerized interpretation may be clinically more useful because it is immediately available.