The Annals of Family Medicine encourages readers to develop a diverse learning community to think critically about important issues affecting primary care, conduct journal clubs, and act on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article and provides discussion tips and questions. Post a summary of your conversation in our online discussion. (Open the article and click on “TRACK Discussion/ Submit a comment.”) Discussion questions and information are online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
Discussion Tips
Many patients present to primary care physicians with symptoms that are suspicious for cardiac arrhythmias, but 12-lead ECGs to evaluate the symptoms are not always available or are cumbersome. This article describes a blinded case series to evaluate the utility of a smartphone-enabled 1-lead ECG.
Discussion Questions
What does this study investigate and why does this matter?
How is this study different from previous studies about smartphone-enabled ECGs? What does this study add to the field?
How strong is the study design to answer the researchers’ questions?
Define sensitivity, specificity, likelihood ratios, positive/ negative predictive value. How are these calculated?
What were the primary and secondary findings of the study? How accurate was 1-lead ECG for detecting atrial fibrillation/atrial flutter vs other arrhythmias vs ectopic beats? Is there value in combining these end points?
Importantly, what does this study not investigate?
To what degree can the findings be accounted for by:
How patients were selected, excluded, or lost to follow-up; how the main variables were measured?; confounding variables; and how the findings were interpreted?
How applicable are the study results to your patient population? How applicable are the study results in a typical primary care office? What is the transportability of the findings?
How might spectrum bias be relevant to this study?
How might the study change your practice? Would you be more likely to use a smartphone-enabled 1-lead ECG in your office or at home visits?
What are the limitations of the study and how may this limit the applicability of the results?
How does this study relate to and differ from the discussion around using smartphone ECG as a screening tool?4
What are next steps in applying the findings to clinical practice and in primary care?
What research questions remain regarding the use of smartphone-enabled 1-lead ECGs in primary care?
- © 2019 Annals of Family Medicine, Inc.