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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 2  |  Page : 94-97

Availability and utilization of electrocardiogram as cardiac diagnostic tool in private hospitals in Port Harcourt


Department of Medicine, Faculty of Clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria

Date of Web Publication3-Jul-2019

Correspondence Address:
Dr. Chibuike Eze Nwafor
Department of Medicine, Faculty of Clinical Sciences, University of Port Harcourt, Port Harcourt
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njc.njc_8_18

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  Abstract 


Background: Electrocardiography is a low cost, easy to perform method of investigation of the cardiovascular system with diagnostic and prognostic value, and great clinical usefulness. There is an increasing prevalence of cardiovascular disease in Africa and other developing nations of the world. The private hospitals serve as the first port of call to a large number of cardiac patients. Hence, they need to determine the availability and utilization of electrocardiogram (ECG) in the private hospitals.
Methodology: This is a cross-sectional, descriptive study involving medical practitioners who offer medical services in the private hospitals in Port Harcourt. A structured self-administered questionnaire was used in this study with a total of 120 analyzable data generated.
Results: In this study, 72.5% of the respondents were male with females constituting 27.5%. Most of the respondents were general practitioners and mostly < 10 years of medical practice. This study found that approximately two-third of the respondents had ECG facility in their practice with good utilization (83.2%). However, most of the respondents (60%) have no formal training in the interpretation of ECG with only 6.2% having competence in ECG interpretation, and only 15.6% would seek specialist opinion/interpretation. This study further found that 98.3% of the respondents expressed willingness for formal training to improve their ECG interpretation skills.
Conclusion: There are good availability and utilization of ECG facilities among private practitioners in Port Harcourt. The knowledge and competence for interpretation of ECG are poor. There is, therefore, a need for formal training in ECG interpretation for general and private medical practitioners in Port Harcourt, Nigeria.

Keywords: Availability, electrocardiogram, private hospitals, utilization


How to cite this article:
Alikor CA, Nwafor CE. Availability and utilization of electrocardiogram as cardiac diagnostic tool in private hospitals in Port Harcourt. Nig J Cardiol 2018;15:94-7

How to cite this URL:
Alikor CA, Nwafor CE. Availability and utilization of electrocardiogram as cardiac diagnostic tool in private hospitals in Port Harcourt. Nig J Cardiol [serial online] 2018 [cited 2019 Sep 21];15:94-7. Available from: http://www.nigjcardiol.org/text.asp?2018/15/2/94/262007




  Introduction Top


Electrocardiograms (ECGs) are noninvasive cardiac diagnostic tool that is useful in the primary care setting.[1],[2] In comparison to echocardiography and other cardiac diagnostic imaging modalities, ECGs are inexpensive, simple, and reproducible.[3],[4] The ECG which was first described in the early 20th century by Einthoven has remained critical in the evaluation of different cardiac diseases and their subsequent follow-up even as documented in the American College of Cardiology and the American Heart Association report of 1992.[2]

In spite of the importance of this tool in daily primary care cardiac diagnostic and screening services, not much is documented about its availability in the primary care setting and similarly its utilization, especially in the African setting. There is also a paucity of information on the level of training obtained by primary care clinicians in ECG interpretation. This becomes quite important to maximize the benefits of this simple and noninvasive cardiac tool, especially as some documentation in the Western world have shown that interpretive skills in primary care are variable and anecdotal evidence exists that recording quality may be suboptimal.[1],[3],[5]

The aim of this study, therefore, is to assess ECG availability, utilization, interpretation skills, and training needs of the clinician in the private practice.


  Methodology Top


This is a cross-sectional descriptive study involving medical practitioners in the private practice setting in Port Harcourt, South-South Nigeria. Analyzable data were generated through a structured self-administered questionnaire. The questionnaire sought to assess the biodemographic data of the study participants and questions on ECG availability, ECG request including frequency and indications for such request. Other data elicited by the questionnaire included the level of training on ECG interpretation, self-reported ECG interpretation competence of the private practitioners, dependence on machine-generated report, seeking of specialist opinion/interpretation, and willingness for formal ECG training.

It was sent to 180 private practice clinicians. 120 clinicians responded. One questionnaire was completed per clinician.


  Results Top


Response rate

A total of 120 clinicians responded representing an overall response rate of 66.6%. Majority of the respondents were male (72.5%) with a male-to-female ratio of 2.6:1.

The majority (66.7%) of the respondents fall within the young age group of <40 years, and only 6.7% of respondents were more than 60 years of age [Table 1].
Table 1: Age distribution of respondents

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The majority of the respondents were medical officers as shown in [Table 2]. Most of the respondents were general practitioners and mostly <10 years of medical practice.
Table 2: Status of respondents

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Approximately two-third of the respondents had ECG services available in their facility with good utilization [Table 3]. Majority of the clinicians (53%) request 1–5 ECGs per month and the most common reason for requesting ECG by the private practitioners was palpitation followed by chest pain [Table 4] and [Table 5].
Table 3: Electrocardiogram availability and request

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Table 4: Electrocardiogram request/month

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Table 5: Indications for electrocardiogram

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Interpreting electrocardiograms

As extracted from [Table 6], only 6.2% interpret ECG with very good competence on self-assessment, 51.9% depend on the machine-generated report. Most of the respondents (60%) have no formal training in the interpretation of ECG. On the overall, 15.6% would seek specialist opinion/interpretation. A striking 98.3% of study respondents expressed willingness for formal ECG training.
Table 6: Self-reported electrocardiogram interpretation competence

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  Discussion Top


The recording and interpretation of ECGs in the general practice and private practice setting have become increasingly common, and many private practitioners have accepted it as part of core general medical service. However, there are limited data on the provision of ECG recording and interpretation in private practice. Even, less is known about the level of training and the quality of the service. It was recognized that the majority of the respondents in this study were males which is consistent with the expectations that males are more in private practice. This study found that the majority (63%) had ECG facility and services in their practice in tandem with the findings in a primary care ECG survey in North East England, where 76.5% recorded ECGs in house.[5]

The utilization of ECG services was found to be high in this study as 83% reported utilization which is in consonant to the deposition by Wolf et al., where survey confirmed that the majority of practices (76.5%) recorded ECGs in house.[5] Wolf et al. further reported a striking variation in the number of ECGs performed per 1000 among the private practices.[5] This study found out also that ECG request per month varied among the study respondents. In a study by Isiguzo et al. involving mostly senior resident doctors of four training family medicine departments in Nigeria, the utilization of ECG was found to be poor with a small percentage of participants making more than five ECG requests per week.[6] This again is in tandem with a large multicenter study in Turkey, where nearly half of the study participants never ordered ECG for their patients.[7] The explanation for these variations in our study may not be completely understood; however, it may be related to capacities and expertise of the different private practices including the population and demographic dynamics.

As depicted in this study, only a small number of practices refer or seek a specialist interpretation of suspected abnormal ECG with slightly above half of the respondents depending on the machine-generated report. This is much higher than the 25% reported by Wolf et al. for nonrecording practices and reliance on interpretive ECG software.[5] Although the machine-generated ECG reports may be useful in the reduction of ECG interpretation errors, it may also be misleading to the primary care physicians.[8],[9] Araoye et al., in their work, on reviewing the reliability of computer analysis of ECG of Nigerians clearly elucidated that the criteria mostly used could not be applied to the blacks.[10] In the work by Araoye et al., the following errors were further highlighted: poor recognition of constitutional variables leading to disparity in the diagnosis of the left ventricular hypertrophy (areas based on voltage criteria), myocardial infarction (areas based on depolarization and repolarization changes), and atrial fibrillation (areas based on accurate sensing of P-waves).[10] It is, therefore, important that private practitioners are knowledgeable on ECG interpretation, and that they do not depend on system-generated reports which may not always be a proper representation of the outcome, especially among the Negroes. In the work by Wolf et al., over 4/5th of ECG recording practices had a member of staff who interpreted the ECGs and 20% of practices used secondary care to report all or at least some of their ECGs either through formal or informal systems.[5] The use of secondary care to interpret ECGs was found to be higher with practices that did not record ECGs, and 23% of practices relied on the report from an interpretive machine which is lower than reported in this study.[5] Clinicians were asked to rate their competences of ECG interpretations, and only an abysmal 6.2% of the study respondents reported good competence in ECG interpretation in the present study. It is, therefore, not surprising as the majority did not have any formal training similar to the findings by Isiguzo et al. where approximately 70% of the study participants did not update their knowledge of ECG.[6] The result has to be with the understanding that they are self-reported competence without formal assessment.[11]


  Conclusion Top


This study has shown a good availability and utilization of ECG facility and services in private practice in Port Harcourt, Nigeria. The self-reported training, knowledge, and competence for interpretation of ECG are poor, and there is, therefore, a need for formal training in ECG interpretation for general and private medical practitioners in Port Harcourt, Nigeria.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fye WB. A history of the origin, evolution, and impact of electrocardiography. Am J Cardiol 1994;73:937-49.  Back to cited text no. 1
    
2.
Schlant RC, Adolph RJ, DiMarco JP, Dreifus LS, Dunn MI, Fisch C, et al. Guidelines for electrocardiography. A report of the American College of Cardiology/American Heart Association Task Force on assessment of diagnostic and therapeutic cardiovascular procedures (Committee on electrocardiography). Circulation 1992;85:1221-8.  Back to cited text no. 2
    
3.
Fisch C. The chemical electrocardiograin: A classic. Circulation 1980;62 Suppl 3:1-4.  Back to cited text no. 3
    
4.
Macfarlane PW. The coming of age of electrocardiology. In: Macfarlane PW, Vietch Lawrie TD, editors. Comprehensive Electrocardiology: Theory and Practice in Health and Disease. Vol. 1. New York: Pergamon Press; 1989. p. 3-40.  Back to cited text no. 4
    
5.
Wolf AR, Long S, McComb JM, Richley D, Mercer P. The gap between training and provision: A primary care based ECG survey in North-Easth England. Br J Cardiol 2012;19:38-40.  Back to cited text no. 5
    
6.
Isiguzo GC, Iroezindu MO, Muoneme AS, Okeahialam BN. Knowledge and utilization of electrocardiogram among resident doctors in family medicine in Nigeria. Niger J Clin Pract 2017;20:1133-8.  Back to cited text no. 6
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7.
Set T, Akturk Z, Buyuklu M, Cansever Z, Avsar UZ, Avsar U, et al. Improving electrocardiogram interpretation skills among primary care physicians. Turk J Med Sci 2012;46:1028-52.  Back to cited text no. 7
    
8.
Willems JL, Abreu-Lima C, Arnaud P, van Bemmel JH, Brohet C, Degani R, et al. The diagnostic performance of computer programs for the interpretation of electrocardiograms. N Engl J Med 1991;325:1767-73.  Back to cited text no. 8
    
9.
Hillson SD, Connelly DP, Liu Y. The effects of computer-assisted electrocardiographic interpretation on physicians' diagnostic decisions. Med Decis Making 1995;15:107-12.  Back to cited text no. 9
    
10.
Araoye MA, Omotoso AO, Opadijo GO, Aderidigbe A. Reliability of computer analysis of electrocardiograms (ECG) of Nigerians. J Med Trop 2010;12:9-13.  Back to cited text no. 10
    
11.
Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L, et al. Accuracy of physician self-assessment compared with observed measures of competence: A systematic review. JAMA 2006;296:1094-102.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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Abstract
Introduction
Methodology
Results
Discussion
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