ECG practices in a geriatric population within a quaternary hospital: a cross-sectional analysis

Electrocardiograms (ECGs) are commonly performed in hospitals as part of clinical assessment and could be an opportunity to detect other incidental health conditions. This study aims to examine ECG practices among elderly patients at high risk of Atrial Fibrillation (AF) and stroke within a quaternary hospital setting and the prevalence of potentially clinically significant findings. Cross-sectional analysis of all patients ≥75 years admitted to a large quaternary hospital. Data extracted from the electronic medical record included patient demographics, comorbidities, reason for presentation, and ECG records. Each ECG was reviewed by two Cardiologists, with discrepancies resolved by a third Cardiologist. ECGs were assessed according to American Heart Association/American College of Cardiology (AHA/ACC) recommendations. Of 226 patients, [age 82.97±6.16, F = 112 (49.56%)], 92.5% (209/226) patients had an ECG performed during their admission. Among the 209 ECGs, interpretation of findings was only reported in clinical documentation for 113 (54.1%). Of the 198/209 ECGs able to be retrieved for review, only 97 (49.0%) had been signed by a clinician as being sighted. The 198 ECGs analysed independently by two Cardiologists, resulted in 396 ECG reviews, of which 364 (91.9%), were considered technically adequate and only 30 ECGs (15.3%) were assessed as normal by both reviewers. The most common abnormalities were conduction disease (160/392 ; 40.8%), arrhythmia (148/392; 37.8%) and ischaemia (41/392; 10.5%). 72 (31.8%) patients in this study had known AF, of whom 14 (19.4%) were not anticoagulated and 8 (11.1%) were not on the guideline-recommended dose of anticoagulation. This study highlights the burden of ECG abnormalities and a gap in the treatment of AF in elderly patients. There is opportunity to improve detection and facilitate earlier management of AF and other clinically significant ECG findings through a more robust ECG reporting system.