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An electrocardiogram (ECG) is the mainstay of cardiac evaluation available in primary care, after which assessment in relation to clinical symptoms and signs is made by family physicians to assess the patients holistically. Subsequently, based on this clinical evaluation, patients may then be referred for tertiary review at a cardiology department or managed in primary care. In Singapore, ECG abnormalities found in asymptomatic patients may require a specialist review and thus make up a substantial number of patients referred by primary care physicians from public healthcare polyclinics to cardiology outpatient clinics. Some of these patients may be clinically managed in primary care with no further evaluation necessary, yet others may require a non-urgent or expedited review.

Purpose- This study investigates the moderating role of accounting conservatism in the relationship between corporate financial decisions (financial leverage, investment rate, and dividend payout policy) and the likelihood of financial distress among firms listed on the Kenyan Securities Exchange. Design/Methodology- The study analyzed a sample of 45 firms over 14 years from 2008 to 2021, resulting in 630 firm-year observations. Panel logistic regression was employed to assess secondary data from annual financial reports. Findings- Results reveal that financial leverage and investment rate significantly increase financial distress risk, while dividend payout policy has a negative effect. Accounting conservatism moderates these relationships by reducing the impact of financial leverage and enhancing the effect of dividend policy. Practical Implications- Managers should implement conservative accounting practices to align incentives with long-term shareholder interests, ensuring prudent financial reporting and minimizing financial distress risks. Originality- This research contributes to the understanding of financial decisions and distress, offering insights into the role of accounting conservatism in promoting corporate financial stability.