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Prevalence of ECG abnormalities in an international survey of patients with suspected or confirmed heart failure at death or discharge
Author(s) -
Khan Nasrin K.,
Goode Kevin M.,
Cleland John G.F.,
Rigby Alan S.,
Freemantle Nick,
Eastaugh Joanne,
Clark Andrew L.,
Silva Ramesh,
Calvert Melanie J.,
Swedberg Karl,
Komajda Michael,
Mareev VIu,
Follath Ferenc
Publication year - 2007
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2006.11.003
Subject(s) - medicine , heart failure , cardiology , patient discharge , medline , intensive care medicine , emergency medicine , medical emergency , political science , law
Background Most patients suspected of having heart failure (HF) will get a 12‐lead electrocardiogram (ECG) but its utility for excluding HF or assisting in its management has rarely been investigated. Methods The EuroHeart Failure survey identified 11,327 patients hospitalised with a suspected diagnosis of HF from 115 hospitals in 24 countries. ECGs were obtained from 9315 patients, of whom 5934 had cardiac imaging tests. The utility of the ECG was assessed for excluding or diagnosing major structural heart disease (MSHD) or major left ventricular systolic dysfunction (MLVSD) and for therapeutic decision making. Findings MSHD was present in 70% and MLVSD in 54% of patients overall but in only 21% and 5%, respectively, if the ECG was entirely normal. However, <2% of patients had a normal ECG. No single ECG characteristic identified a probability <25% of MSHD or <20% of MLVSD. Patients with QRS width ≥120 ms or anterior pathological Q‐waves had a probability >80% of MSHD and >70% of MLVSD. Diagnostic models suggested that electrocardiographic criteria alone were not accurate for the diagnosis or exclusion of important heart disease in this population. However, 2468 patients (42%) had an electrocardiographic finding that should be used to guide the choice of therapy. Conclusions A normal ECG is rare in patients with suspected HF but has limited diagnostic value in this setting. The ECG has an important role in guiding therapy.