Ritmo certo - a new website in arrhythmology designed for primary care
Authors: Santos J , Novais C , Alves C , Salgado J , Figueiredo F , Mendonca E , Gouveia P M , Brito D B , Reis A H , Vieira A P , Roque C , Sousa M J , Oliveira F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Electrocardiogram (ECG) is the most performed cardiovascular tool in medicine(1). First described by Einthoven at the beginning of the 20th century, it is now a useful, cheap and safe exam, accessible to millions of people on devices as light as smartwatches.
Several studies have demonstrated the variability in the ECG interpretation. A recent systematic review described a low median accuracy of 54%, across different training levels (from students to experimented Cardiologists), and suggested that continuous training with courses, software and databases significantly improves that accuracy(2).
With the easy access to this exam, along with the high prevalence of arrhythmias, Primary Care Physicians play an important role in this ECG era. Nevertheless, some articles reported that they too make frequent errors in interpretation and feel "uncomfortable" dealing with the 120 diagnostic ECG patterns described(3).

Purpose
To develop a website designed to aid Primary Care Physicians in diagnosing and managing patients with most ECG diagnostic patterns.

Methods
Literature regarding ECG pattern diagnosis and management was reviewed. The research combined European and North American guidelines, medical textbooks and websites, reviews and original articles available on Pubmed. The website information was assembled and written by Primary Care Physicians, then reviewed by Cardiologists that work in the Arrhythmology area.

Results
It was created an open, free access, nonprofitable, continuously updated website, written in Portuguese, that has 4 main components: 1. A Homepage with a search toolbar; 2. An "Index Page", with all the ECG diagnostic statements organized as a book index (FIGURE1); 3. A "Toolkit" link, with tools that are useful in ECG management such as CHA2DDS2-VASc and HASBLED scores, doses and contraindications of drugs, etc (FIGURE2).; 4. When searching for an ECG pattern, the user can access a summarized text with its definition, causes, exams that might be required (e.g. echocardiogram), and management (FIGURE1). The management section organizes procedures from the most to the less urgent.
A version of the website is available and fully functional for testing purposes. The website will be continuously updated with images of all ECG diagnostic patterns from a local hospital database and specific information for pediatrics, pregnant women, and athletes.

Conclusion
Nowadays, Primary Care Physicians face a fascinating era of increasing amounts of information, fast discoveries and possibilities that demand permanent attention and update. The ECG is a complex but valuable and accessible tool with more than 100 different diagnostic statements. With this website, the aim is to empower Primary Care Physicians so they can confidently interpret ECG, and also manage patients according to the best medical recommendations available, with an updated tool fully designed for them.