24 Hour ECG Clinical Guidance - Burngreave Surgery

Author: Lisa Platts, Practice Manager, Burngreave Surgery

Date published: October 2018

Date to review: April 2021

The Burngreave Surgery

5 Burngreave Road

SHEFFIELD

S3 9DA

Telephone: 0114 2725619

Fax: 0114 2798004

Dr Peter Mooney Dr Joanna Beattie

Stage 1 – The consultation

It is up to the patients GP to determine whether the patient has a level of risk which requires specialist assessment.

Patients will be included in this diagnostic pathway (a subset of the overall cardiac pathway) by their GP if they report symptoms of:

  • palpitations,
  • irregularity,
  • feelings of dizziness,
  • light headedness,
  • “fainting or falls” (note these patients require a careful assessment of risk of significant problems warranting urgent specialist assessment.)

Patients experiencing palpitations less frequently than daily should be considered by their GP for loop event recorder investigation.

The patients GP should take a history and perform any necessary examination. If this reveals any high risk factors (see below) then there should be a referral to an appropriate specialist service. Patients who at clinical interview or examination have severe symptoms or have high risk (eg FHx, sudden death under 40 years) should be excluded from this pathway and be referred to a specialist service. Other symptoms which raise clinical concern, should be discussed with an appropriate clinician to decide if a 24 hour ECG would be helpful or not.

Before referral to the 24 hour ECG Service, a resting 12-lead ECG and appropriate blood tests should be carried out. PLEASE LET THE PATIENTS KNOW THAT THEY CANNOT HAVE A SHOWER WHEN THE LEADS ARE FITTED AND THAT THEY SHOULD NOT TRY AND REMOVE THE LEADS DURING THIS PERIOD.

Patients with significant abnormalities detected in the 12-lead ECG should be referred to secondary care.

Low Risk group

Patients who fulfil the following criteria should initially be treated conservatively:

· No history of sustained tachycardia or loss of consciousness AND

· Good exercise capacity AND

· No family history of Sudden Cardiac Death < 40 years AND

· Normal cardiac examination AND

· Normal 12 lead ECG

Stage 2 – referral to local service provider for 24-hour ECG investigation

Referrals to Burngreave Surgery can be made using the referral form on the Press Portal either via ERS or by emailing referral form to SHECCG.BurngreaveSurgery@nhs.net. If referring via ERS, please ensure that that patients are given a printout of their UBRN number and contact number for Burngreave Surgery. Please encourage patients to contact Burngreave surgery within 2 days of being referred quoting the UBRN number.

Burngreave Surgery will fit the patient with the device and provide the patient with a patient information leaflet and their contact details should any problems/concerns arise. We will advise the patient on the time to return the device the following day to the surgery.

Stage 3

Designated staff at Burngreave surgery will download the recordings and transmit for interpretation in PDF format using a secure electronic method along with the original referral form.

DNA’s

Should a patient fail to attend an appointment and does not contact the Surgery to re-book, Burngreave Surgery will inform the referring GP.

Stage 4

The Provider of this service will send a report back to the patients registered GP electronically by NHS.net.

Stage 5

The patient is informed of the results by their registered practice and managed as appropriate.

Note – the Provider should aim to not undertake any repeat scanning of patients unless there is clinical rationale for the repeat scan.