In Norway there used to be a five days course in interpreting ECG with a final exam that gave the physicians the permission to use a special interpretation rate when reading ECG. This rate is not granted any more, probably with the consequence that the physicians who order the ECGs have no formal competency in interpreting the ECGs.
In Italy the preparticipation screening (PPS) of ECG are conducted by sports physicians who attend postgraduate residency training programs in sports medicine (and sports cardiology) full-time for 4 years and work in sports medical centers specifically devoted to periodical screening of athletes. These physicians played a crucial role for achieving the accuracy of first line cardiovascular screening.
In the United States most PPS is performed by generalists without subspecialty training.
To find the most efficient way to interpret the ECG of athletes during screening.
45 GPs and 45 cardiologists will be given anonymous demographic data, positive findings from the questionnaires, BP data and ECG with computer interpretation from ten players. They will be asked to categorize the ECG as 1) abnormal, 2) normal or 3) athletes heart. The cardiologists' answers at baseline will be compared with the GPs after intervention. As intervention the GPs will learn the most important features in the new recommendations for interpreting ECG in athletes and they will be given a leaflet with the most important points.
After one month they will be asked to categorize ten new ECGs. They will also be asked to recommend follow up each time, categorized as 1) control of ECG, 2) new cardiologist assessment, 3) 24 hours ECG control, 4) exercise ECG, 5) MRI cor, 6) blood pressure control, 7) contact team doctor or GP or 8) no follow up needed. The results will be compared with the project’s expert group’s answers, and echocardiographic findings.
Expectations and hypothesis
Small interventions are needed to reduce the number of false positive ECG findings to an acceptable minimum.
Cost effective screening of athletes according to recommendations can be accomplished by trained team physicians and not necessarily by cardiologists.