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The electrocardiogram (ECG) has been used in population studies for over 40 years. The value of such research from an electrocardiographic standpoint relates to determining the prognostic value of various ECG abnormalities. The prevalence and prognostic significance of ECG abnormalities have recently been comprehensively reviewed,1 following an earlier extensive summary of the ECG in epidemiology and clinical trials.2The most recent survey in the current issue ofHeart from a Belgian team3concentrates on the prevalence of various ECG abnormalities in the general population through an analysis of ECGs from 47 358 men and women; as such, it builds on earlier reports from the same authors where the prognostic significance of ECG abnormalities in a subset of the same population was reported.4 5
Methods and accuracy of coding
Most population based studies make use of the Minnesota Code, first introduced in 19606 and subsequently extended to incorporate serial comparison in 1983.7 An updated manual is due for publication shortly. Coding of an ECG can be done manually as in the paper of De Bacquer and colleagues3 or it can be done by automated methods.8 Both approaches, however, are subject to error9 10 and 100% reliance cannot be placed on either the coding of one individual or an automated technique. In the case of manual coding, it is better to have two individuals coding independently and then reaching a consensus in the event of disagreement, or if the coding centre is large enough, a third (more experienced) observer can adjudicate. Automated codings should be reviewed by an observer who effectively provides a second opinion. Even then, a second observer is also of value when there is disagreement between an automated report and the first observer. There is much that can be regarded as subjective in coding an ECG …
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