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Rapid response to:


Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial

BMJ 2007; 335 doi: (Published 23 August 2007) Cite this as: BMJ 2007;335:380

Rapid Response:

Thoughts from General Practice

Mant et al give us much to think about and the results as published
are disappointing for general practitioners. There are a few points in our
defence though:

The authors are correct that we would not routinely analyse 100
electrocardiograms especially without clinical information. It would be
interesting to know if the electrocardiograms were read in the normal
working day, if so when and how much protected time was offered.

General practitioners are a heterogeneous group and it may be more
appropriate to compare us with hospital physicians than with
cardiologists. It is possible that the general practitioners selected did
not all have an interest in cardiology and selecting general practitioners
more specifically may have yielded different results. Indeed the authors
state that the sensitivities of individual doctors varied from 50% to
100%, so some were at least as good as the cardiologists.

Finally the summary of statistics table states that "uncertain diagnoses
were counted as missed diagnoses for sensitivity and as not atrial
fibrillation for specificity". Dealing with uncertainity is an area
general practitioners are particularly good at. They would not have
normally filed an uncertain electrocardiogram in the medical records but
would have discussed it with a colleague either in the surgery or at the
local hospital to come to a diagnosis. This usual process was not followed
and the results do not therefore reflect normal practice. An idea of the
number of uncertain diagnoses would put this in proportion.

Competing interests:
None declared

Competing interests: No competing interests

05 September 2007
Ralph Emmerson
General Practitioner
Imperial Rd, Matlock. DE4 5FE