Erroneous computer-based interpretations of atrial fibrillation and atrial flutter in a Swedish primary health care setting

Abstract

Objective: To describe the incidence of incorrect computerized ECG interpretations of atrial fibrillation or atrial flutter in a Swedish primary care population, the rate of correction of computer misinterpretations, and the consequences of misdiagnosis.

Design: Retrospective expert re-analysis of ECGs with a computer-suggested diagnosis of atrial fibrillation or atrial flutter.

Setting: Primary health care in Region Kronoberg, Sweden.

Subjects: All adult patients who had an ECG recorded between January 2016 and June 2016 with a computer statement including the words ‘atrial fibrillation’ or ‘atrial flutter’.

Main outcome measures: Number of incorrect computer interpretations of atrial fibrillation or atrial flutter; rate of correction by the interpreting primary care physician; consequences of misdiagnosis of atrial fibrillation or atrial flutter.

Results: Among 988 ECGs with a computer diagnosis of atrial fibrillation or atrial flutter, 89 (9.0%) were incorrect, among which 36 were not corrected by the interpreting physician. In 12 cases, misdiagnosed atrial fibrillation/flutter led to inappropriate treatment with anticoagulant therapy. A larger proportion of atrial flutters, 27 out of 80 (34%), than atrial fibrillations, 62 out of 908 (7%), were incorrectly diagnosed by the computer.

Conclusions: Among ECGs with a computer-based diagnosis of atrial fibrillation or atrial flutter, the diagnosis was incorrect in almost 10%. In almost half of the cases, the misdiagnosis was not corrected by the overreading primary-care physician. Twelve patients received inappropriate anticoagulant treatment as a result of misdiagnosis.

Key points

• Data regarding the incidence of misdiagnosed atrial fibrillation or atrial flutter in primary care are lacking. In a Swedish primary care setting, computer-based ECG interpretations of atrial fibrillation or atrial flutter were incorrect in 89 of 988 (9.0%) consecutive cases.

• Incorrect computer diagnoses of atrial fibrillation or atrial flutter were not corrected by the primary-care physician in 47% of cases.

• In 12 of the cases with an incorrect computer rhythm diagnosis, misdiagnosed atrial fibrillation or flutter led to inappropriate treatment with anticoagulant therapy.

Keywords:

• ECG
• atrial fibrillation
• atrial flutter
• computer-based interpretation
• cardiovascular disease

Acknowledgements

We thank Helene Ringenson (Cardiolex) for technical assistance in retrieving the ECGs from the digital database.

Disclosure statement

TL, JK, HT and OP report no conflicts of interest. EL has received lecture fees from Medtronic, St Jude Medical, Biotronik, AstraZeneca and Boehringer Ingelheim.

Additional information

Funding

This research has received funding from the Department of Research and Development, Region Kronoberg, Sweden; Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden.