Family Practice, Vol 15, 343-353, Copyright © 1998 by World Organization of Family Doctors
PJ Zwietering, JA Knottnerus, PE Rinkens, MA Kleijne and AP Gorgels
BACKGROUND: Complaints possibly caused by arrhythmias are frequently seen
in general practice. It is unclear to what extent such complaints can
differentiate between arrhythmias and other pathology in general practice.
OBJECTIVES: We aimed to assess the value of symptoms (a) in diagnosing
arrhythmias in general practice and (b) in identifying patients with
clinically relevant arrhythmias. METHOD: During a 2-year period, a
structured history from 762 patients with new complaints possibly related
to an arrhythmia was taken by the GP, and a transtelephonic
electrocardiogram (ECG) was made. RESULTS: In 28.3% of the patients,
arrhythmias were detected and 8.8% were clinically relevant. Several
patient characteristics, symptoms and medical history findings have high
predictive values in diagnosing arrhythmias. In the logistic regression
analysis, age and, to a lesser extent, male gender, palpitations and
dyspnoea during consultation and the use of cardiovascular drugs are
associated with the presence of arrhythmias. In detecting clinically
relevant arrhythmias the same parameters apart from gender are important,
as well as a history of arrhythmias. The use of central nervous system
medication and frequent psychosomatic complaints are negatively associated
with the presence of clinically relevant arrhythmias. CONCLUSIONS: In
general practice, patient characteristics, symptoms and medical history
findings can be used in the detection of arrhythmias and the assessment of
their severity. They can help in the decision of whether to make an ECG
recording.
ORIGINAL CLINICAL RESEARCH
Arrhythmias in general practice: diagnostic value of patient characteristics, medical history and symptoms
Department of General Practice, Maastricht University, The Netherlands.
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