Author + information
- Barbara J. Drew, RN, PhD∗ (, )
- Kathleen Dracup, RN, PhD,
- Rory Childers, MD,
- John Michael Criley, MD,
- Gordon Fung, MD,
- Frank Marcus, MD,
- David Mortara, PhD,
- Michael Laks, MD and
- Mel Scheinman, MD
- ↵∗Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, California 94143-0610
The standard 12-lead electrocardiogram (ECG) is the most commonly performed cardiac diagnostic test because it provides vital information about cardiac rhythm, acute myocardial injury, and a host of other abnormalities while also being simple to perform, risk free, and inexpensive. Historically, ECG readers have been trained in cardiology and clinical electrocardiography. However, mentoring of cardiology trainees in clinical electrocardiography has been superseded by a host of emerging diagnostic and treatment modalities such as invasive procedures, imaging techniques, cardiac device therapies, and cardiogenomics. As a result, there is an ever-shrinking pool of cardiologists who have the expertise or desire to read ECGs. In the United States, most ECGs are read by noncardiologists (emergency, internal-medicine, and family-practice physicians) who have had minimal training in clinical electrocardiography (1). Inadequate training of ECG readers has also led to an overreliance on computerized measurements/interpretations that are frequently inaccurate.
In some hospitals, there is already an inadequate supply of ECG readers, and the problem is made worse by minimal reimbursement from payers. The small professional fee to a physician for reading an ECG (about $9.00 in the San Francisco area) has forced some hospitals to augment the professional fee at the hospital’s expense in order to find enough readers for the large volume of ECGs generated each day.
The relevant question is whether it is time to consider training and certifying cardiovascular nurse practitioners to read ECGs, thereby supplementing the shrinking pool of expert ECG readers. Cardiologists have confronted similar challenges in the past. For example, at the initiation of coronary care units, cardiologists delegated arrhythmia interpretation to specially trained coronary care unit nurses (2,3). We believe that it is time to consider training and certifying nurse practitioners specializing in cardiology to read ECGs.
Please note: Dr. Mortara is president and founder of Mortara Instrument. Dr. Scheinman receives speaker’s fees for lectures to cardiology fellows from St. Jude Medical, Medtronic, Biotronik, Biosense, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation