Should general practitioners use the electrocardiogram to select patients with suspected heart failure for echocardiography?
Patient referrals from general practice for suspected heart failure are increasing the demand for echocardiograms, many of which are normal. We investigated whether general practitioners could be more selective by referring only patients with abnormal electrocardiograms for echocardiography. The electrocardiograms of 200 patients attending a heart failure clinic were analysed by a consultant cardiologist and two general practitioners. All three assessors examined the electrocardiograms independently and unaware of the echocardiography results. The correlation between abnormal electrocardiograms and left ventricular systolic dysfunction on echocardiography was assessed, together with the concordance between the assessors in their electrocardiogram interpretations. One hundred and sixty-five patients had echocardiographic evidence of left ventricular systolic dysfunction. When interpreted by a cardiologist, the electrocardiogram had a sensitivity of 89.1% and a specificity of 45.7% in pr
