Objective: To investigate the diagnostic status and electrocardiographic correlates in patients with biochemical evidence of iron overload. Methods: We conducted a retrospective cohort study of patients in our hospital with ferritin levels exceeding 500 ng/mL between January 1, 2011, and October 24, 2022 (corresponding to the pre-COVID-19 pandemic period in Beijing). Using ICD-10-CM coded medical records, we assessed the following: definitive diagnostic characterization (genetic or acquired), electrocardiographic (ECG) completion rates, and the prevalence of ECG abnormalities. Statistical analyses, encompassing chi-square tests and correlation studies, were performed using SPSS Statistics software (version 27.0). Results: Except for cases of malignancy, infectious diseases, hematological diseases, chronic diseases, for the unexplained diagnosis group found elevated ferritin during annual health checkup, there were 17 cases in the group with ferritin above 1,000 ng/ml and 36 cases in the group with ferritin ranging from 500 to 1,000 ng/ml, accounting for 23.2% and 25.8% of the entire ferritin analysis respectively, and the total proportion in the entire analysis was 24.0%. Among the cases indicating ferritin higher than 500ng/ml, 24.0% of the cases were of unknown diagnosis. ECG acquisition rate for was 55.7%, with 24% demonstrating abnormalities, including atrial fibrillation, sinus tachycardia arrhythmia, atrioventricular block, prolonged QT interval, T-wave inversion, and ST-segment depression. Conclusion: The study revealed that the proportion of unexplained diagnoses of ferritin overload remains relatively high, and the analysis of the ECG is also insufficient. There is a need to enhance clinicians’ awareness and attention to iron overload in both diagnosis and ECG analysis.