Scots GPs face IT hitch
Richard Hoey reports on key developments in GPs' diagnostic role at the European Society of Cardiology congress
Electrocardiography cannot exclude the possibility of heart failure and should not be used as the sole means of diagnosing the disease, new research concludes.
A quarter of patients who were recorded by GPs as having a normal ECG had heart failure after all, according to the study.
The researchers urged NICE to review the guidelines for assessing and referring patients with suspected heart failure, saying the current advice was 'flawed'.
The study, presented at last week's European Society of Cardiology congress in Mun-ich, analysed data from 217 patients who received 12-lead ECG at a GP-led one-stop diagnostic clinic for suspected heart failure.
Of 82 patients who were later confirmed with left ventricular systolic dysfunction by full echocardiography, 18 had had a normal ECG. In 12
cases the disease was mild, but in two it was moderate and in four it was severe.
Study author Dr Ahmet Fuat, a GP with special interest in cardiology in Darlington, County Durham, said: 'Our data suggests that if you use an ECG to exclude heart failure, a quarter of patients with a normal ECG would have it. What we really need is a combination of ECG and b-type natriuretic peptide tests.'
Dr Fuat is currently conducting a large-scale evaluation of the combined approach in a primary care setting.
He urged GPs to build up an index of suspicion and to be prepared to refer patients for echocardiography even if an ECG was normal. But he added: 'In the US we would not be having this argument. We don't have enough echocardiography services and we don't have enough cardiologists.'
Co-author Dr Jerry Murphy, consultant cardiologist at Darlington Memorial Hospital, added: 'I think the guidelines are flawed. They work on published papers but the data has moved on and they need to evolve to reflect that. The problem with NICE is that it only looks backwards.' He added that GPs often found ECGs 'daunting' to interpret.
Dr Strat Liddiard, national GP clinical lead for the CHD collaborative and a GP in Poole, Dorset, said: 'There's evidence even general physicians in hospitals miss minor abnormalities in ECGs. We're at a transition in terms of service provision and what I'd like to see is the BNP test becoming more widely available.'