Community Volunteers Successfully Trained to Do ECG Screening

March 10, 2013

SAN FRANCISCO, California — Community volunteers, namely parents, can be trained to perform an accurate electrocardiogram (ECG) screening, according to the results of a new study presented here today at the American College of Cardiology 2013 Scientific Sessions. Overall, the rate of technical error in nearly 4500 ECGs performed by community volunteers on five consecutive screening days was just 0.34%, a rate that was comparable to that of trained ECG technicians.

"We decided that we were just going to do screenings in the community," said senior investigator Dr Joseph Marek (Advocate Medical Group, Oak Brook Terrace, IL). "The clinical conditions are not common, so we figured we had to screen large numbers where we could design a cost-effective, sustainable program. We didn't want it to be a one- or two-time thing that a hospital was willing to sponsor for public relations. So we came up with the idea of having parents trained in how to do the ECGs. If they could figure out how to use their cell phone, they could figure out how to do an ECG."

To heartwire , Marek explained that the inspiration for the screening program came from the Italian model. In Italy, all young athletes are screened before they are allowed to compete in sports, which involves a physical exam, family history, and screening with a 12-lead ECG. At present, the American Heart Association (AHA) and American College of Cardiology (ACC) do not recommend the use of ECGs for cardiovascular screening of athletes at any level, nor does the Canadian Heart and Stroke Foundation.

Given the controversy that currently surrounds feasibility and cost of widespread screening, the Young Hearts for Life ECG screening program trains community volunteers to accurately perform a 12-lead ECG during screening exams. In doing, so, some of the cost is removed from the equation. The volunteers are trained during a 90-minute information session and later supervised by experienced staff (one staff member for every 12 volunteers).

"When they walk out of there, they are capable of performing an ECG," said Marek. With the physician who reads the ECG donating time, the cost per screening is just $10 to $20 per patient, adds Marek.

In the data presented, 4477 ECGs were performed by community volunteers. Of these, just 15 were deemed technically inadequate (0.34%) and included eight limb lead reversals, six misplaced pericardial leads, and one missing lead. In the literature, the published technical error rate among trained ECG technicians is 0.4%.

"The criticism of doing screening in this country is that it's not feasible, but I think we've shown that we can do it," said Marek. "The other criticism is that there would be too many abnormalities. It was suggested that there could be 10% to 40% abnormal ECGs that would dwarf the medical community evaluating these kids, but we've shown that it's 2% or less. So it's doable.

Marek said the Young Hearts for Life program typically approaches the school, but word of mouth has spread, and now they are being contacted. Approximately 700 students can undergo ECG screening in a day, and parent–teacher associations and booster clubs are responsible for recruiting volunteers. "They recruit them, we train them, we supervise them, and then we get the screenings done," said Marek.

In order to avoid any potential conflicts of interest, any student identified through the program with an abnormality, such as long-QT syndrome or Wolff-Parkinson-White syndrome, would have the information sent directly to the family and physician, who would then conduct an evaluation or referral.

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