[cliffdover]

I always wondered how precise were the computerized ECG interpretations from 24-48h Holter results. Considering you have to take notes and report date and time whenever you feel "something" it might need a manual check.

Edit: Code is open source and found it here https://github.com/awni/ecg

[arkades]

They’re pretty shit. Probably half of the essentially normal EKGs I see come with the automated interpretation of “Abnormal EKG,” and no meaningful information. You absolutely 100% cannot rely on them, and all doctors are trained - from the get-go - not to.

[jazoom]

Yup. We pretty much just ignore what the machine says.

[haradwaith]

Here are Cardiologs we have developed a FDA-cleared software to analyze Holter recordings.

Our algorithm uses deep neural networks to detect arrhythmia. The physician reviews and update manually our analysis before generating their final report.

This leads to an efficient analysis in a minimum of time. They can even analyze multiple-weeks recordings painlessly without spending hours on it.

https://cardiologs.com/

[Aduket]

interesting, does it analyze 12 leads? is your data publicly available? is there any article detailing the DNN you developed? thanks.

[haradwaith]

Yes! Our algorithm can analyze 12-lead resting ECGs, and detect 76 different pathologies. Here is an article that has been published recently: https://www.sciencedirect.com/science/article/pii/S002207361...

[GordonS]

Years ago I had to wear a Holter device for 24h, and wondered the same when I was asked to note the time of any events.

I've also had a 12-lead ECG done 3 times that I recall Each time it was done by a nurse rather than a doctor, and each time they barely even glanced at the output before announcing everything was OK. Is ECG output really that easy to read and unambiguous?

[arkades]

> Is ECG output really that easy to read and unambiguous?

Not even close. But nurses generally don’t know how to read EKGs except for the most obvious findings, so when they say “it’s all fine” either they mean they don’t see something very conspicuous (ST elevations, widened QRS, absent p waves), or they’re just giving you the default “stay calm, and wait for the doc to read it” comment.

The only non-docs I’ve ever seen impress me with their EKG reads have been some experienced EMTs, really experienced critical care nurses / mid levels, and some experienced cardiology mid-levels. In short, people that do it every single day and have been doing it for a long while. And even they don’t do it with an instant glance.

EKGs are more complicated than they look. Each lead gives you a different slice through the heart; some of the leads are in the xz axis, and some are in the xy axis, and findings are modified by height, weight, position, metabolic profile, etc. Basic EKG reading takes an hour to learn; being good at it takes forever.

The catch about the above study is that they are doing the easiest possible thing: categorizing arrhythmias. That’s the part you can learn in an hour. Doing it “as well as a cardiologist” just isn’t impressive. Give me a couple of weeks with a bright high schooler and they’ll be doing rhythm classification as well as most doctors.

It’s “precisely which part of the heart is malfunctioning, what part of the vasculature or conduction pathway or whatever does that implicate, and based on the patient’s medical history what underlying diagnosis does that imply? And what is the next best step in medical management?” that cardiologists interpret EKGs for.