Appropriate use of Exercise Electrocardiograms in an Academic Hospital in Johannesburg

Abstract

Abstract Aims Exercise electrocardiograms (ExECGs) are widely used in resource-limited settings to screen for patients with chest pain of unknown origin. Despite this, the appropriate use of the ExECG has never been determined. We aimed to evaluate whether ExECGs, to investigate patients with chest pain of unknown origin, were being done appropriately in Johannesburg. Methods We retrospectively evaluated 318 consecutive ExECGs done on patients between 1 January 2018 and 31 December 2019, at a single tertiary centre, the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). This included ExECGs for patients selected in the Cardiology department and those referred from other hospitals and departments. Following the 2019 European Society of Cardiology (ESC) Guidelines for diagnosing and managing chronic coronary syndromes, solely those patients at intermediate pretest probability of occlusive CAD using the Diamond-Forester Classification were considered appropriate. Results Only 130 (40.9%) patients in our study sample had a documented pretest risk stratification to establish pretest probability, of which 75 patients (57.7%) were documented as having an intermediate pretest likelihood of CAD. The pretest risk stratification of the remaining 188 patients of the total study population could not be determined. When these patients without a pretest risk stratification are considered inappropriate then only 23.6% are at intermediate risk for CAD. Conclusion In our study, we found that only 23.6% of ExECGs performed at the CMJAH for the evaluation of chest pain of unknown origin were appropriate. (232 words)