Effects of cardiology review of the electrocardiogram in patients with suspected acute coronary syndromes.

BACKGROUND

Misclassification of the electrocardiogram (ECG) contributes to treatment errors in patients with acute coronary syndrome. We hypothesized that cardiology ECG review could reduce these errors.

OBJECTIVE

The purpose of this study is to examine the effects of real-time cardiology ECG review in patients evaluated for acute coronary syndrome.

METHODS

A prospective observational study was done on weekdays, 8 AM to 11 PM, from April 28, 2006, to October 27, 2006, in an urban academic medical center. Eligible subjects were those aged 21 years with chest pain or the equivalent. Those with ECGs considered "normal" or "unchanged from baseline" were excluded. Emergency physicians completed a data sheet and faxed the ECG to a cardiology fellow for review. The primary outcome was the effect of the cardiology review on emergency department (ED) triage and treatment decisions. We excluded those who eloped or left against medical advice (AMA) or those cases wherein the cardiology fellow came to evaluate the patient. Data included demographics, clinical and ECG characteristics, and a 3-month outcome. We used descriptive statistics with 95% confidence intervals.

RESULTS

One hundred forty-nine ECGs were faxed to a cardiology fellow. One hundred twenty cases were analyzed. Excluded were AMA/eloped/ineligible (n = 11) and those whose cardiology forms were unavailable (n = 18). Subjects were aged (median) 50.5 years (range, 24-93 years), 50% (n = 60) were female, and 87.5% (n = 105) had cardiac markers in ED. Cardiology ECG review triggered callback in 6 cases (5.0%; 95% confidence interval, 1.5%-10.9%) with documented discussion with a cardiology fellow about treatment. In 3 cases (2.5%; 95% confidence interval, 0.5%-7.1%), disposition was changed to coronary care unit and cardiac catheterization consulted, although none were emergently treated.