NHS North Kirklees CCG ECGs in Primary Care.

Descriptions

Aims and ObjectivesThe aim of the service is to provide patient access to ECG investigation within primary care settings and timely interpretation of the results in order to provide prompt diagnosis and management, and to:1. Prevent unnecessary referrals to hospital for 12 lead ECG and delays in interpretation.2. Detect atrial fibrillation and offer treatment to prevent strokes.3. Detect people with conduction abnormalities requiring pacemakers.4. Provide timely ECG readings and interpretations in the annual assessment of people with LVSD (on the QoF register).5. Provide timely ECG readings and interpretations to people with newly diagnosed hypertension as part of CV risk stratification.6. Respond to patients presenting with:— Tachycardia,— Bradycardia,— Irregular pulse,— Heart Murmur (significant AS unlikely with a normal ECG),— Breathlessness (combined with FBC and CXR as appropriate),— Chest pain (not acute),— Hypertension (as work up of primary prevention),— Palpitations,— Syncope (even single episodes),— Family history of Sudden Cardiac Death,— Current palpitation (if not decompensated).Service outlineThe ECG is a non-invasive test that involves correctly placing 12 adhesive electrode leads on the patient's chest and limbs and recording the results for interpretation. It is simple to perform, taking just a few minutes, and requires minimal training. It can be performed safely by GPs, practice nurses, and health care assistants in the GP setting or in the home where patients are house-bound.ECG reporting and interpretation can be more difficult and may be undertaken by a competent clinician or via telemedicine reporting to a specialist service.This specification does not include care pathways for the management of the different conditions but does refer to care pathways where an ECG is required.All practice ECGs will be reported within 24 hours either by a trained clinician or by a telemedicine service. The ECG interpretation will be reported to the patient on the same working day where it is clinically indicated.Population coveredThis service should be available to:— People with newly diagnosed hypertension as part of CV risk stratification,— People presenting with symptoms of chest pain, palpitations, breathlessness or transient loss of consciousness – though taking the ECG should not delay admission to hospital in those whose condition is clinically indicated,— People presenting with symptomatic or asymptomatic irregular pulse,— People with established heart failure,— Prior to echocardiogram.ExclusionsPatients presenting with acute chest pain typical of an Acute Coronary Syndrome will be referred immediately to the A&E Department.NICE recommends provision of an ECG in practice for those with chest pain (query acute coronary syndrome), which should be sent to hospital in advance of the patient; however conducting the ECG test should not delay the transfer to hospital.