Prehospital Electrocardiographic Assessment in Patients with Cardiac Disease in Urban Zhangzhou

LIN Qiuhui; ZHENG Wenkai; LIN Yiqing; YAN Jiani

doi:10.13919/j.issn.2095-6274.ZHJY202507012

Abstract：Objective To examine the status of prehospital electrocardiogram(ECG)testing among patients with cardiac disease in urban Zhangzhou.Methods We collected data on 1,624 patients with cardiac disease from the dispatch records of the Zhangzhou Emergency Medical Center between January 2022 and December 2024.A retrospective analysis was performed to assess the ECG testing rate and positivity rate,the distribution of ECG abnormalities across age groups,and patterns of misdiagnosis.Results Of 1,624 patients,805(49.57％)under-went ECG testing.Among those tested,641(79.63％)had positive findings.ECG testing rates in 2023 and 2024 were significantly higher than in 2022(P＜0.05),whereas the ECG positivity rate in 2022 was higher than in 2023 and 2024(P＜0.05).Common ECG abnormalities included ST-T changes,arrhythmias,myocardial ischemia,and critical abnormalities.The prevalence of ECG abnormalities increased with age,with the＞60-year group exhibit-ing a significantly higher abnormality rate than other age groups(P＜0.001);ST-T changes were the most frequent finding across all ages.Among 641 patients with positive ECGs,69 were misdiagnosed,yielding an overall mis-diagnosis rate of 10.76％.Misdiagnosis rates for acute myocardial infarction,arrhythmias,and electrolyte distur-bances were 13.90％,9.28％,and 55.56％,respectively.Multivariable logistic regression identified calendar year,age 30-60 years,and a chief complaint of typical chest pain as independent predictors of undergoing ECG testing(P＜0.05).Compared with 2022,patients were more likely to receive ECG testing in 2023(OR=1.807,95％CI:1.477～2.212)and 2024(OR=2.694,95％CI:1.813～4.001);patients with typical chest pain were 3.300 times as likely to be tested(OR=3.300,95％CI:2.058～5.291).Patients aged 30-60 years were more likely to be tested than those aged＜30 years(OR=1.406,95％CI:1.088～1.818),whereas the difference between the＞60-year group and the＜30-year group was not statis-tically significant(P=0.154).Conclusion ECG plays a pivotal role in prehospital emergency care for cardiac diseases;however,current prehospital practice shows suboptimal testing rates and a nontrivial rate of misdiagnosis,attributable to atypical tracings and limited interpretation skills.Strengthening standardized,symptom-directed workflows and enhancing emergency personnel's competence in interpreting complex ECGs are key to improving the quality of prehospital emergency care.