Predictive value of history taking and physical examination in diagnosing arrhythmias in general practice
Abstract
BACKGROUND: Palpitations and light-headedness are common symptoms that may be indicative of cardiac arrhythmias. Effective triage by the GP might prevent delayed treatment or inappropriate referrals. The aim of this study was to determine the capability of GPs to assess the presence of cardiac arrhythmias and which signs and symptoms are used in predicting the presence of arrhythmias and which actually are related to the presence of arrhythmias. METHODS: A consecutive cohort of 127 patients presenting with palpitations and/or light-headedness to 41 GPs in the Netherlands underwent physical examination, patient history and standard electrocardiogram. The GPs' estimation of the probability of patients having an arrhythmia was compared with the diagnostic result of 30 days of continuous event recording (CER). We assessed discriminating factors that can assist a GP in diagnosing an arrhythmia. RESULTS: No correlation was found between the GPs' assessment of risk and actual diagnoses. GPs were more likely to predict an arrhythmia in patients who suffer from hypertension (P=0.049) or patients with a history of cardiovascular disease (P=0.006). Vasovagal symptoms [odds ratio (OR)=2.91, 95% confidence interval (CI) 1.1-7.6] and bradycardia (OR=4.2, 95% CI 1.3-14.0) were significantly more common in patients with a CER diagnosis of arrhythmia. CONCLUSION: Prediction of arrhythmias by GPs based on history taking and physical examination alone is not accurate. These parameters are insufficient to decide which patients need further diagnostic evaluation. A diagnostic facility with low threshold for GPs is essential for an adequate diagnostic process in patients with palpitations and light-headedness.
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In general, older patients and men are more likely to have an arrhythmic cause of palpitations and younger patients and women a psychosomatic cause.
“In general, however, older patients and men are more likely to have an arrhythmic cause of palpitations and younger patients and women a psychosomatic cause.47 -51”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [49]
External and implantable loop recorders, mobile cardiac outpatient telemetry, and pacemakers and ICDs can detect asymptomatic clinically significant arrhythmias automatically, without patient activation.
“The external and implantable loop recorders, mobile cardiac outpatient telemetry, and pacemakers and ICDs can detect asymptomatic clinically significant arrhythmias automatically (i.e. with no activation by the patient)”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [49]
External and implantable loop recorders, mobile cardiac outpatient telemetry, and pacemakers and ICDs provide a significantly higher yield than standard patient-activated loop recorders in patients with infrequent palpitations.
“and provide a significantly higher yield than standard patient-activated loop recorders in patients with infrequent palpitations.49,73 -79”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [49]
Cites
Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine
Mann, D. L., Zipes, D. P., Libby, P., Bonow, R. O., & D, E. B. M. (2011) · Medical Entomology and Zoology · Cited by 3,745 · see citing works
Robinson, R. (1993) · BMJ · doi:10.1136/bmj.307.6907.793 · Cited by 819 · see citing works
ACC/AHA guidelines for ambulatory electrocardiography
Crawford, M. H., Bernstein, S. J., Deedwania, P. C., DiMarco, J. P., Ferrick, K. J., Garson, A., Green, L. A., Greene, H. L., Silka, M. J., Stone, P. H., et al. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00354-x · Cited by 309 · see citing works
Kinlay, S., Leitch, J. W., Neil, A., Chapman, B. L., Hardy, D. B., & Fletcher, P. J. (1996) · Annals of Internal Medicine · doi:10.7326/0003-4819-124-1_part_1-199601010-00003 · Cited by 245 · cited 2× · see citing works
“(2,7,9) The advantage of the CER over other diagnostic instruments is that the registration of an event is directly linked to experience of symptoms.”
BackgroundEvaluation and outcomes of patients with palpitations
Weber, B. E., & Kapoor, W. N. (1996) · The American Journal of Medicine · doi:10.1016/s0002-9343(97)89451-x · Cited by 196 · see citing works
Zimetbaum, P. J., Kim, K. Y., Josephson, M. E., Goldberger, A. L., & Cohen, D. J. (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-128-11-199806010-00002 · Cited by 133 · see citing works
Reiffel, J. A., Schwarzberg, R., & Murry, M. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2005.01.025 · Cited by 131 · see citing works
Aronow, W. S. (2006) · Medical Clinics of North America · doi:10.1016/j.mcna.2006.05.009 · Cited by 68 · see citing works
Palatini, P., Longo, D., Zaetta, V., et al. (2006) · Journal of Hypertension · doi:10.1097/01.hjh.0000234118.25401.1c · Cited by 53 · see citing works
Characteristics of patients presenting to a cardiac clinic with palpitation
Mayou, R. (2003) · QJM · doi:10.1093/qjmed/hcg017 · Cited by 52 · see citing works
Zwietering, P. J., Knottnerus, J. A., Rinkens, P. E. L. M., Kleijne, M. A. W. J., & Gorgels, A. P. M. (1998) · Family Practice · doi:10.1093/fampra/15.4.343 · Cited by 49 · see citing works
Summerton, N., Mann, S., Rigby, A., Petkar, S., & Dhawan, J. (2001) · Family Practice · doi:10.1093/fampra/18.4.383 · Cited by 49 · see citing works
Hoefman, E., van Weert, H. C. P. M., Reitsma, J. B., Koster, R. W., & Bindels, P. (2005) · Family Practice · doi:10.1093/fampra/cmi048 · Cited by 45 · see citing works
Self-citationPrognostic value of ventricular arrhythmias in systemic hypertension
Galinier, M., Balanescu, S. M., Fourcade, J., et al. (1997) · Journal of Hypertension · doi:10.1097/00004872-199715120-00089 · Cited by 45 · see citing works
The value of the ECG in the diagnosis of supraventricular tachycardias
Wellens, H. J. J. (1996) · European Heart Journal · doi:10.1093/eurheartj/17.suppl_c.10 · Cited by 24 · see citing works
Evidence based checklists for objective structured clinical examinations
Frank, C. (2006) · BMJ · doi:10.1136/bmj.38943.463565.68 · Cited by 19 · see citing works
Bridging the gaps in evidence based diagnosis
Straus, S. E. (2006) · BMJ · doi:10.1136/bmj.38945.464722.80 · Cited by 12 · see citing works
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Raviele, A., Giada, F., Bergfeldt, L., Blanc, J. J., Blomstrom-Lundqvist, C., Mont, L., Morgan, J. M., Raatikainen, M. J. P., Steinbeck, G., Viskin, S., et al. (2011) · Europace · doi:10.1093/europace/eur130 · Cited by 149 · see citing works
Does this patient with palpitations have a cardiac arrhythmia?
Thavendiranathan, P. (2009) · JAMA · doi:10.1001/jama.2009.1673 · Cited by 75 · see citing works
- Authors
- Hoefman, E., Boer, K. R., van Weert, H. C., Reitsma, J. B., Koster, R. W., & Bindels, P. J.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Venue
- Family Practice
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-11-13
- Volume
- 24
- Issue
- 6
- Pages
- 636-641
- ISSN
- 0263-2136 (ISSN-L)
- 1460-2229
- OpenAlex
- W2113914569
- Cited by
- 20
- References
- 17
- Citations by year
- 2023: 1 · 2021: 3 · 2018: 2 · 2016: 1 · 2015: 2 · 2012: 4
- FWCI
- 1.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Family Practice (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- H2020 European Research Council
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- cardiac arrhythmias, palpitations, lightheadedness, general practitioners, clinical history taking, physical examination, arrhythmia diagnosis, bradycardia, hypertension, cardiovascular disease history, diagnostic accuracy, triage
- MeSH terms
- Adolescent, Adult, Arrhythmias, Cardiac, Family Practice, Female, Humans, Male, Medical History Taking, Middle Aged, Netherlands, Physical Examination, Predictive Value of Tests, Cohort Studies
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