Crowther George, Ahmed Noura, Kasa Deepa, Goff Zoe, Tayebjee Muzahir H
Leeds and York Partnership NHS Foundation Trust, UK.
University of Leeds, UK.
BJPsych Bull. 2023 Feb;47(1):11-16. doi: 10.1192/bjb.2021.108.
People diagnosed with dementia are often started on acetylcholinesterase inhibitors (AChEIs). As AChEIs can be associated with cardiac side-effects, an electrocardiogram (ECG) is sometimes requested before treatment. Previous work has suggested there is little consensus as to when or how ECGs should be obtained. This can create inconsistent practice, with patient safety, economic and practical repercussions. We surveyed 305 UK memory clinic practitioners about prescribing practice.
More than 84% of respondents completed a pulse and cardiac history before prescribing AChEIs. Opinion was divided as to who should fund and conduct ECGs. It was believed that obtaining an ECG causes patients inconvenience and delays treatment. Despite regularly interpreting ECGs, 76% of respondents did not update this clinical skill regularly.
The variation in practice observed has service-level and patient implications and raises potential patient safety concerns. Implementing national guidelines or seeking novel ways of conducting cardiac monitoring could help standardise practice.
被诊断为痴呆症的患者通常会开始使用乙酰胆碱酯酶抑制剂（AChEIs）。由于AChEIs可能会伴有心脏副作用，因此有时在治疗前会要求进行心电图（ECG）检查。先前的研究表明，对于何时以及如何进行心电图检查，几乎没有达成共识。这可能导致实践不一致，对患者安全、经济和实际操作产生影响。我们对305名英国记忆诊所的从业者进行了关于处方实践的调查。
超过84%的受访者在开具AChEIs之前完成了脉搏和心脏病史检查。对于谁应该资助和进行心电图检查，意见存在分歧。人们认为进行心电图检查会给患者带来不便并延误治疗。尽管经常解读心电图，但76%的受访者没有定期更新这项临床技能。
观察到的实践差异对服务水平和患者有影响，并引发了潜在的患者安全问题。实施国家指南或寻求进行心脏监测的新方法可能有助于规范实践。
