Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors
نویسندگان
چکیده
OBJECTIVE New electronic devices offer an opportunity within routine primary care settings for improving the detection of atrial fibrillation (AF), which is a common cardiac arrhythmia and a modifiable risk factor for stroke. We aimed to assess the performance of a modified blood pressure (BP) monitor and two single-lead ECG devices, as diagnostic triage tests for the detection of AF. SETTING 6 General Practices in the UK. PARTICIPANTS 1000 ambulatory patients aged 75 years and over. PRIMARY AND SECONDARY OUTCOME MEASURES Comparative diagnostic accuracy of modified BP monitor and single-lead ECG devices, compared to reference standard of 12-lead ECG, independently interpreted by cardiologists. RESULTS A total of 79 participants (7.9%) had AF diagnosed by 12-lead ECG. All three devices had a high sensitivity (93.9-98.7%) and are useful for ruling out AF. WatchBP is a better triage test than Omron autoanalysis because it is more specific-89.7% (95% CI 87.5% to 91.6%) compared to 78.3% (95% CI 73.0% to 82.9%), respectively. This would translate into a lower follow-on ECG rate of 17% to rule in/rule out AF compared to 29.7% with the Omron text message in the study population. The overall specificity of single-lead ECGs analysed by a cardiologist was 94.6% for Omron and 90.1% for Merlin. CONCLUSIONS WatchBP performs better as a triage test for identifying AF in primary care than the single-lead ECG monitors as it does not require expertise for interpretation and its diagnostic performance is comparable to single-lead ECG analysis by cardiologists. It could be used opportunistically to screen elderly patients for undiagnosed AF at regular intervals and/or during BP measurement.
منابع مشابه
Detecting and Diagnosing Atrial Fibrillation (D2AF): study protocol for a cluster randomised controlled trial.
BACKGROUND Atrial fibrillation is a common cause of stroke and other morbidity. Adequate treatment with anticoagulants reduces the risk of stroke by 60 %. Early detection and treatment of atrial fibrillation could prevent strokes. Atrial fibrillation is often asymptomatic and/or paroxysmal. Case-finding with pulse palpation is an effective screening method, but new methods for detecting atrial ...
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Atrial fibrillation (AF) is a significant risk factor for stroke and early detection of AF may help to identify patients in need of treatment. Automated blood pressure (BP) monitors with implemented AF or arrhythmia detection systems may be a useful tool for early diagnosis of AF. A systematic review (Medline/PubMed, Embase, Cochrane) of studies was performed to assess the accuracy of modified ...
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ED FROM Mant J, Fitzmaurice DA, Hobbs FDR, et al. Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial. BMJ 2007;335:380. Correspondence to: Dr D A Fitzmaurice, University of Birmingham, Birmingham, UK; [email protected] So...
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