Current Computerized ECG Interpretation Models
Computerized algorithms designed to interpret 12-lead standard (12 SL) ECGs have been commercially available since early 1980s.25 Currently, computer generated ECG interpretations are widely used to provide ‘first pass’ interpretations which are then over-read by trained technicians and physicians. Most of these models use traditional statistical algorithms and require intensive feature extraction and engineering to compute. Misdiagnoses are not uncommon with this approach especially if the reliance on computer generated interpretation is high.13,26 For instance, in a retrospective review computer interpreted diagnosis of AF was incorrect in 35% of the 1085 patients.27Furthermore, the physician ordering the ECG failed to correct the interpretation in 10% of these patients. This has significant downstream effects e.g., inappropriate management and unnecessary testing.27 In one recent study, about 10% misinterpretation rates were reported for AF- 47% of which were not corrected by overreading primary care physicians.28Analysis from the SAFE (screening for atrial fibrillation in the elderly) trial, assessing diagnostic accuracy of general practitioners (from 49 practices) and traditional computer interpretations to diagnose AF revealed 20% missed AF cases and 8% false positives compared to reference standard cardiologists.29 These studies highlight the limitations of current computer algorithms used to interpret ECGs and the devastating consequences on patient outcomes when there is an overreliance on them.