Can 24 h of ambulatory ECG be used to triage patients to extended monitoring?
Abstract Background Access to long‐term ambulatory recording to detect atrial fibrillation (AF) is limited for economical and practical reasons. We aimed to determine whether 24 h ECG (24hECG) data can predict AF detection on extended cardiac monitoring. Methods We included all US patients from 2020...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Annals of Noninvasive Electrocardiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/anec.13090 |
| _version_ | 1797627653585371136 |
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| author | Linda S. Johnson Alexandra Måneheim Magdalena Slusarczyk Agnieszka Grotek Olga Witkowska Justinas Bacevicius Leif Sörnmo Marek Dziubinski Sanjeev Bhavnani Jeffrey S. Healey Gunnar Engström |
| author_facet | Linda S. Johnson Alexandra Måneheim Magdalena Slusarczyk Agnieszka Grotek Olga Witkowska Justinas Bacevicius Leif Sörnmo Marek Dziubinski Sanjeev Bhavnani Jeffrey S. Healey Gunnar Engström |
| author_sort | Linda S. Johnson |
| collection | DOAJ |
| description | Abstract Background Access to long‐term ambulatory recording to detect atrial fibrillation (AF) is limited for economical and practical reasons. We aimed to determine whether 24 h ECG (24hECG) data can predict AF detection on extended cardiac monitoring. Methods We included all US patients from 2020, aged 17–100 years, who were monitored for 2–30 days using the PocketECG device (MEDICALgorithmics), without AF ≥30 s on the first day (n = 18,220, mean age 64.4 years, 42.4% male). The population was randomly split into equal training and testing datasets. A Lasso model was used to predict AF episodes ≥30 s occurring on days 2–30. Results The final model included maximum heart rate, number of premature atrial complexes (PACs), fastest rate during PAC couplets and triplets, fastest rate during premature ventricular couplets and number of ventricular tachycardia runs ≥4 beats, and had good discrimination (ROC statistic 0.7497, 95% CI 0.7336–0.7659) in the testing dataset. Inclusion of age and sex did not improve discrimination. A model based only on age and sex had substantially poorer discrimination, ROC statistic 0.6542 (95% CI 0.6364–0.6720). The prevalence of observed AF in the testing dataset increased by quintile of predicted risk: 0.4% in Q1, 2.7% in Q2, 6.2% in Q3, 11.4% in Q4, and 15.9% in Q5. In Q1, the negative predictive value for AF was 99.6%. Conclusion By using 24hECG data, long‐term monitoring for AF can safely be avoided in 20% of an unselected patient population whereas an overall risk of 9% in the remaining 80% of the population warrants repeated or extended monitoring. |
| first_indexed | 2024-03-11T10:28:23Z |
| format | Article |
| id | doaj.art-2ec8b2fab2fc4e2993bffc771b5df07e |
| institution | Directory Open Access Journal |
| issn | 1082-720X 1542-474X |
| language | English |
| last_indexed | 2024-03-11T10:28:23Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Noninvasive Electrocardiology |
| spelling | doaj.art-2ec8b2fab2fc4e2993bffc771b5df07e2023-11-15T06:40:29ZengWileyAnnals of Noninvasive Electrocardiology1082-720X1542-474X2023-11-01286n/an/a10.1111/anec.13090Can 24 h of ambulatory ECG be used to triage patients to extended monitoring?Linda S. Johnson0Alexandra Måneheim1Magdalena Slusarczyk2Agnieszka Grotek3Olga Witkowska4Justinas Bacevicius5Leif Sörnmo6Marek Dziubinski7Sanjeev Bhavnani8Jeffrey S. Healey9Gunnar Engström10Department of Clinical Sciences Lund University Lund SwedenDepartment of Clinical Sciences Lund University Lund SwedenMEDICALgorithmics Warsaw PolandMEDICALgorithmics Warsaw PolandMEDICALgorithmics Warsaw PolandInstitute of Clinical Medicine, Faculty of Medicine Vilnius University Vilnius LithuaniaDepartment of Biomedical Engineering Lund University Lund SwedenMEDICALgorithmics Warsaw PolandHealthcare Innovation and Practice Transformation Laboratory, Scripps Clinic La Jolla‐Genesee Executive Plaza San Diego California USAPopulation Health Research Institute, McMaster University Hamilton Ontario CanadaDepartment of Clinical Sciences Lund University Lund SwedenAbstract Background Access to long‐term ambulatory recording to detect atrial fibrillation (AF) is limited for economical and practical reasons. We aimed to determine whether 24 h ECG (24hECG) data can predict AF detection on extended cardiac monitoring. Methods We included all US patients from 2020, aged 17–100 years, who were monitored for 2–30 days using the PocketECG device (MEDICALgorithmics), without AF ≥30 s on the first day (n = 18,220, mean age 64.4 years, 42.4% male). The population was randomly split into equal training and testing datasets. A Lasso model was used to predict AF episodes ≥30 s occurring on days 2–30. Results The final model included maximum heart rate, number of premature atrial complexes (PACs), fastest rate during PAC couplets and triplets, fastest rate during premature ventricular couplets and number of ventricular tachycardia runs ≥4 beats, and had good discrimination (ROC statistic 0.7497, 95% CI 0.7336–0.7659) in the testing dataset. Inclusion of age and sex did not improve discrimination. A model based only on age and sex had substantially poorer discrimination, ROC statistic 0.6542 (95% CI 0.6364–0.6720). The prevalence of observed AF in the testing dataset increased by quintile of predicted risk: 0.4% in Q1, 2.7% in Q2, 6.2% in Q3, 11.4% in Q4, and 15.9% in Q5. In Q1, the negative predictive value for AF was 99.6%. Conclusion By using 24hECG data, long‐term monitoring for AF can safely be avoided in 20% of an unselected patient population whereas an overall risk of 9% in the remaining 80% of the population warrants repeated or extended monitoring.https://doi.org/10.1111/anec.13090ambulatory ECGatrial fibrillationpredictionrisk scorestroke |
| spellingShingle | Linda S. Johnson Alexandra Måneheim Magdalena Slusarczyk Agnieszka Grotek Olga Witkowska Justinas Bacevicius Leif Sörnmo Marek Dziubinski Sanjeev Bhavnani Jeffrey S. Healey Gunnar Engström Can 24 h of ambulatory ECG be used to triage patients to extended monitoring? Annals of Noninvasive Electrocardiology ambulatory ECG atrial fibrillation prediction risk score stroke |
| title | Can 24 h of ambulatory ECG be used to triage patients to extended monitoring? |
| title_full | Can 24 h of ambulatory ECG be used to triage patients to extended monitoring? |
| title_fullStr | Can 24 h of ambulatory ECG be used to triage patients to extended monitoring? |
| title_full_unstemmed | Can 24 h of ambulatory ECG be used to triage patients to extended monitoring? |
| title_short | Can 24 h of ambulatory ECG be used to triage patients to extended monitoring? |
| title_sort | can 24 h of ambulatory ecg be used to triage patients to extended monitoring |
| topic | ambulatory ECG atrial fibrillation prediction risk score stroke |
| url | https://doi.org/10.1111/anec.13090 |
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