Abstract 4359065: Inequities in Ambulatory Electrocardiogram Use for Palpitations in the United States

Introduction: Palpitations may be an early manifestation of serious arrhythmias. Disparities in cardiovascular care by sex, race, and geography are well documented, but whether disparities exist in evaluation of palpitations with electrocardiography (ECG) use is unknown. Research Questions/Hypothesis: Among patients presenting with palpitations, are there demographic differences in who receives an ECG? Methods: We conducted a cross-sectional analysis of the National Ambulatory Medical Care Survey from 2014–2016 and 2018–2019. We included outpatient visits for adults (≥18 years) with a chief complaint of palpitations. We excluded surgical visits and visits with participants with congestive heart failure or coronary artery disease. We used weighted log-binomial regression to assess associations between ECG use and patient and provider characteristics, including sex, race/ethnicity, provider specialty, visit type, metropolitan statistical area (MSA) status, insurance type, and age. We report prevalence ratios (PR) and their associated 95% confidence intervals. Analyses were conducted using R version 4.3.2. Results/Data: A total of 494 visits, representing ~21.9 million United States outpatient visits, were included. The median age was 57 years; 70% were female, and 93% resided in metropolitan areas; 68% were non-Hispanic White. Overall, 34.8% (95% CI: 25.7-45.1%) of visits included an ECG. Rural residence was significantly associated with lower ECG use (PR 0.12, 95% CI: 0.03-0.55). Patients with new or exacerbated chronic problems were more likely to receive an ECG (PR 1.60, 95% CI: 1.03-2.47). Medical specialists tended to be more likely than primary care practitioners to perform ECGs (PR 1.75, 95% CI: 0.92-3.30). No significant differences were observed by sex, race/ethnicity, or insurance status. Conclusion(s): Despite the importance of ECGs in evaluating palpitations, only one-third of visits for palpitations included an ECG. Visits in rural settings were less likely to receive an ECG, highlighting geographic inequities in early cardiovascular evaluation. These findings highlight the need for improved access and standardization in diagnostic care for symptomatic patients, particularly in rural settings.