EASI™ 12-lead ECG with a handheld computer refines cardiovascular diagnosis in general practice

Background: Electrocardiogram (ECG) is used to a small extent in general medicine, because of general practitioner (GP) apprehension about interpretation and time consumption. Aim: This study tested the hypothesis that user-friendly EASI ECG improves GP diagnosis of cardiovascular symptoms. Method: Patients over 18 years with recent cardiovascular symptoms or auscultation rhythm abnormalities were included in this prospective, multicentric study (10 practices, 17 GPs). ECG recordings were made with Cardiosecur (R) (4-lead ECG connected to a handheld computer for EASI (TM) processing). Besides clinical data, diagnosis/patient referral were noted before and after ECG and interpretation. GP diagnosis and ECG interpretation were compared with a reference diagnosis made by ECG specialist. Results: There were 338 patients; 66% had cardiovascular risk factors. ECGs were performed for chest pain (41%), auscultation rhythm abnormalities (33%) or palpitations (19%). Average time to perform ECG was 4.7 +/- 2.1 min, with possible home recordings. Compared with standard ECG, improvement provided by Cardiosecur (R) was scored 9/10 (range 7-10) by GPs. GPs correctly interpreted ECG normality/abnormality in 77% of patients. Diagnosis was correctly changed for 14% of patients thanks to the ECG, and wrongly changed for 2%. One new appropriate final diagnosis was achieved for 9 ECG recordings (p < 0.001). Diagnostic certainty increased 1.9 +/- 2.1/10 (p < 0.001). ECG brought about changes in GP decision making: referral or treatment changed for 82 patients (24%) and complementary test for 69 patients (20%). Conclusion: The EASI (TM) algorithm coupled with a handheld computer facilitates ECG recordings in the primary care setting, providing improved diagnosis.

Automated summary

The use of user-friendly EASI ECG improved the diagnosis and decision making of general practitioners in cardiovascular symptoms, leading to improved patient outcomes.