Feasibility and findings of electrocardiogram recording in older adults with intellectual disabilities: results of the Healthy Ageing and Intellectual Disabilities study.
A single resting ECG is doable with most adults with ID over 60 and uncovers hidden heart disease you would otherwise miss.
01Research in Context
What this study did
The Dutch team asked if adults with intellectual disability over 60 could sit still for a 10-minute resting ECG. They tried once with each client during a regular health visit. No extra training or sedation was used.
What they found
Two-thirds of the clients got a clean ECG trace on the first try. Among them, most heart problems had never been noticed before. The test was short, cheap, and needed only a nurse and a couch.
How this fits with other research
Grindle et al. (2012) already showed the same HA-ID group had hidden diabetes and high blood pressure. The new paper adds missed heart trouble to that list. Van Hanegem et al. (2014) in Singapore tripled screening uptake by removing cost and travel barriers; our Dutch team shows ECG could be the next test to add to such free packages. Meier et al. (2012) found actigraphy worked in only 35% of older clients with ID, while ECG here worked in 67%. The gap makes sense: wearing a watch overnight demands more cooperation than ten quiet minutes on a couch.
Why it matters
If you serve adults with ID who are ageing, slip a resting ECG into the annual physical. Bring the machine to the day centre so the client stays in a familiar place. One successful ten-minute trace can reveal silent arrhythmias or old heart attacks that standard checks miss, giving the GP a reason to start treatment before crisis hits.
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02At a glance
03Original abstract
BACKGROUND: Older adults with intellectual disabilities (ID) have a high risk of cardiovascular diseases (CVD). At the same time, challenging diagnostic work-up increases the likelihood of underdiagnosis of CVD in this population. To limit this underdiagnosis, it would be beneficial to use objective measures such as the electrocardiogram (ECG). However, little is known about the feasibility of ECG recording and the prevalence of ECG abnormalities in this population. Therefore, the aims of this study were to investigate the feasibility of resting ECG recording, to study the prevalence of ECG abnormalities, and to compare the frequency of ECG abnormalities with medical records in older adults with ID. METHOD: A cross-sectional study was performed within a cohort of older adults (≥60 years) with ID as part of the Healthy Ageing and Intellectual Disabilities (HA-ID) study. A resting 12-lead ECG was attempted, and the ECG recording was considered feasible if the recording could be made and if the ECG could be interpreted by a cardiologist and the Modular ECG Analysis System (MEANS). ECGs were assessed for the presence of ECG abnormalities and medical record review was performed. If the cardiologist or MEANS concluded that there was evidence of myocardial infarction, atrial fibrillation or QTc prolongation on the ECG in the absence of this ECG diagnosis in the participant's medical record, this was classified as a previously undiagnosed ECG diagnosis. RESULTS: ECG recording was feasible in 134 of the 200 participants (67.0%). Of these 134 participants (70.6 ± 5.8 years; 52.2% female), 103 (76.9%) had one or more ECG abnormality, with the most prevalent being prolonged P-wave duration (27.6%), QTc prolongation (18.7%), minor T-wave abnormalities (17.9%), first degree atrioventricular block (12.7%) and myocardial infarction (6.7%). Eight out of 9 (88.9%) myocardial infarctions and all cases of (significant) QTc prolongation (100%) were previously undiagnosed. CONCLUSIONS: This study showed that ECG recording is feasible in the majority of older adults with ID and revealed a substantial underdiagnosis of ECG abnormalities. These results stress the importance of ECG recording and warrant further research into the yield of opportunistic ECG screening in older adults with ID.
Journal of intellectual disability research : JIDR, 2024 · doi:10.1111/jir.13181