Keywords: Atrial fibrillation, electrocardiography, computer-based
Patients with atrial fibrillation and atrial flutter are common in primary care but data regarding the incidence of misdiagnoses in primary care settings are lacking. We aimed to describe the incidence of incorrect computerized ECG interpretations of atrial fibrillation or atrial flutter in a Swedish primary care population, the rate of correction of computer misinterpretations and the consequences of misdiagnosis.
What is the incidence of misdiagnosis of atrial fibrillation and atrial flutter in a computer-based ECG assessment system in primary care? And what is the impact of misdiagnosis?
We included all adult patients who had an ECG recorded at most primary health care centers in Region Kronoberg, Sweden, between January 2016 and June 2016 with a computer statement including the words “atrial fibrillation” or “atrial flutter”. Retrospective expert re-analysis of ECGs with a computer-suggested diagnosis of atrial fibrillation or atrial flutter was performed.
Of 988 ECGs with a computer diagnosis of atrial fibrillation or atrial flutter 89 (9%) were incorrect, among which 36 were not corrected by the interpreting physician. In 12 cases, misdiagnosed atrial fibrillation/flutter led to inappropriate treatment with anticoagulant therapy. More atrial flutters, 27 out of 80 (34%), than atrial fibrillations, 62 out of 908 (7%), were incorrectly diagnosed by the computer.
In almost thousand consecutive ECGs with a computer-based diagnosis of atrial fibrillation or atrial flutter in a Swedish primary care setting the diagnosis was incorrect in one out of eleven patients and in almost half of these cases the misdiagnosis was not corrected by the interpreting primary care physician. Twelve patients received inappropriate anticoagulant treatment as a result of misdiagnosis.
Points for discussion:
Is there a difference in misdiagnosis between different ECG software assessment systems?
What is the procedure for the diagnosis of afib / afl in your jurisdiction?
How could we minimise misdiagnosis and the consequences of misdiagnosis?