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.