Predictive value of history taking and physical examination in diagnosing arrhythmias in general practice

BACKGROUND: Palpitations and light-headedness are common symptoms that may be indicative of cardiac arrhythmias. Effective triage by the GP might prevent delayed treatment or inappropriate referrals. The aim of this study was to determine the capability of GPs to assess the presence of cardiac arrhythmias and which signs and symptoms are used in predicting the presence of arrhythmias and which actually are related to the presence of arrhythmias. METHODS: A consecutive cohort of 127 patients presenting with palpitations and/or light-headedness to 41 GPs in the Netherlands underwent physical examination, patient history and standard electrocardiogram. The GPs' estimation of the probability of patients having an arrhythmia was compared with the diagnostic result of 30 days of continuous event recording (CER). We assessed discriminating factors that can assist a GP in diagnosing an arrhythmia. RESULTS: No correlation was found between the GPs' assessment of risk and actual diagnoses. GPs were more likely to predict an arrhythmia in patients who suffer from hypertension (P=0.049) or patients with a history of cardiovascular disease (P=0.006). Vasovagal symptoms [odds ratio (OR)=2.91, 95% confidence interval (CI) 1.1-7.6] and bradycardia (OR=4.2, 95% CI 1.3-14.0) were significantly more common in patients with a CER diagnosis of arrhythmia. CONCLUSION: Prediction of arrhythmias by GPs based on history taking and physical examination alone is not accurate. These parameters are insufficient to decide which patients need further diagnostic evaluation. A diagnostic facility with low threshold for GPs is essential for an adequate diagnostic process in patients with palpitations and light-headedness