Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors
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) moni...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
BMJ Publishing Group
2014
|
| _version_ | 1826278339699015680 |
|---|---|
| author | Kearley, K Selwood, M Van Den Bruel, A Thompson, M Mant, D Hobbs, F Fitzmaurice, D Heneghan, C |
| author_facet | Kearley, K Selwood, M Van Den Bruel, A Thompson, M Mant, D Hobbs, F Fitzmaurice, D Heneghan, C |
| author_sort | Kearley, K |
| collection | OXFORD |
| description | 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. |
| first_indexed | 2024-03-06T23:42:27Z |
| format | Journal article |
| id | oxford-uuid:6fc99b6e-9d7f-4a92-9a94-27db797bef3d |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:42:27Z |
| publishDate | 2014 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:6fc99b6e-9d7f-4a92-9a94-27db797bef3d2022-03-26T19:32:52ZTriage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitorsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:6fc99b6e-9d7f-4a92-9a94-27db797bef3dEnglishSymplectic Elements at OxfordBMJ Publishing Group2014Kearley, KSelwood, MVan Den Bruel, AThompson, MMant, DHobbs, FFitzmaurice, DHeneghan, COBJECTIVE: 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. |
| spellingShingle | Kearley, K Selwood, M Van Den Bruel, A Thompson, M Mant, D Hobbs, F Fitzmaurice, D Heneghan, C Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors |
| title | Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors |
| title_full | Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors |
| title_fullStr | Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors |
| title_full_unstemmed | Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors |
| title_short | Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors |
| title_sort | triage tests for identifying atrial fibrillation in primary care a diagnostic accuracy study comparing single lead ecg and modified bp monitors |
| work_keys_str_mv | AT kearleyk triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors AT selwoodm triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors AT vandenbruela triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors AT thompsonm triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors AT mantd triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors AT hobbsf triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors AT fitzmauriced triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors AT heneghanc triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors |