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Opportunistic detection of atrial fibrillation using blood pressure monitors: a systematic review.

Kane SA, Blake JR, McArdle FJ, Langley P, Sims AJ - Open Heart (2016)

Bottom Line: Values for the sensitivity and specificity of AF detection were extracted from each paper and compared.But the studies used different methodologies and many were subject to potential bias.More studies are needed to more precisely define the sensitivity and specificity of opportunistic screening for AF during BP measurement before its clinical utility in the population of interest can be assessed fully.

View Article: PubMed Central - PubMed

Affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.

ABSTRACT

Background: Atrial fibrillation (AF) affects around 2% of the population and early detection is beneficial, allowing patients to begin potentially life-saving anticoagulant therapies. Blood pressure (BP) monitors may offer an opportunity to screen for AF.

Aim: To identify and appraise studies which report the diagnostic accuracy of automated BP monitors used for opportunistic AF detection.

Methods: A systematic search was performed of the MEDLINE, MEDLINE In-Process and EMBASE literature databases. Papers were eligible if they described primary studies of the evaluation of a BP device for AF detection, were published in a peer-reviewed journal and reported values for the sensitivity and specificity. Included studies were appraised using the QUADAS-2 tool to assess their risk of bias and applicability to opportunistic AF detection. Values for the sensitivity and specificity of AF detection were extracted from each paper and compared.

Results and conclusions: We identified seven papers evaluating six devices from two manufacturers. Only one study scored low risk in all of the QUADAS-2 domains. All studies reported specificity >85% and 6 reported sensitivity >90%. The studies showed that BP devices with embedded algorithms for detecting arrhythmias show promise as screening tools for AF, comparing favourably with manual pulse palpation. But the studies used different methodologies and many were subject to potential bias. More studies are needed to more precisely define the sensitivity and specificity of opportunistic screening for AF during BP measurement before its clinical utility in the population of interest can be assessed fully.

No MeSH data available.


Related in: MedlinePlus

Sensitivity and specificity of AF detection for each of the included studies. CIs have been calculated using a binomial approximation as described by Clopper and Pearson.9
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OPENHRT2015000362F2: Sensitivity and specificity of AF detection for each of the included studies. CIs have been calculated using a binomial approximation as described by Clopper and Pearson.9

Mentions: The extracted results for the sensitivity and specificity are shown in figure 2. For the studies where multiple methods for assessing the index test were investigated, the best reported values are shown. In one study14 a discrepancy relating to the specificity of the Microlife BP A200 was noted between the result quoted in the text and the value calculated from the results table; we used the latter. The studies consistently showed that AF detection specificities >85% can be achieved irrespective of the device used, provided that there is an appropriate method for interpreting the index test. Six of the seven studies reported sensitivity >90%. However, in the remaining paper,17 one device demonstrated a much lower sensitivity (30%, Omron M6). This result was in direct conflict with the results obtained by Marazzi et al14 who found a sensitivity of 100% for the same device while still achieving high specificity. Wiesel et al speculate that this difference may be due to the population used by Marazzi et al, which had a high prevalence of AF and relatively young age. However, there have been other studies using populations of similar age11 and a higher prevalence of AF1213 that showed high sensitivities and specificities, so the discrepancy remains unexplained.


Opportunistic detection of atrial fibrillation using blood pressure monitors: a systematic review.

Kane SA, Blake JR, McArdle FJ, Langley P, Sims AJ - Open Heart (2016)

Sensitivity and specificity of AF detection for each of the included studies. CIs have been calculated using a binomial approximation as described by Clopper and Pearson.9
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4836305&req=5

OPENHRT2015000362F2: Sensitivity and specificity of AF detection for each of the included studies. CIs have been calculated using a binomial approximation as described by Clopper and Pearson.9
Mentions: The extracted results for the sensitivity and specificity are shown in figure 2. For the studies where multiple methods for assessing the index test were investigated, the best reported values are shown. In one study14 a discrepancy relating to the specificity of the Microlife BP A200 was noted between the result quoted in the text and the value calculated from the results table; we used the latter. The studies consistently showed that AF detection specificities >85% can be achieved irrespective of the device used, provided that there is an appropriate method for interpreting the index test. Six of the seven studies reported sensitivity >90%. However, in the remaining paper,17 one device demonstrated a much lower sensitivity (30%, Omron M6). This result was in direct conflict with the results obtained by Marazzi et al14 who found a sensitivity of 100% for the same device while still achieving high specificity. Wiesel et al speculate that this difference may be due to the population used by Marazzi et al, which had a high prevalence of AF and relatively young age. However, there have been other studies using populations of similar age11 and a higher prevalence of AF1213 that showed high sensitivities and specificities, so the discrepancy remains unexplained.

Bottom Line: Values for the sensitivity and specificity of AF detection were extracted from each paper and compared.But the studies used different methodologies and many were subject to potential bias.More studies are needed to more precisely define the sensitivity and specificity of opportunistic screening for AF during BP measurement before its clinical utility in the population of interest can be assessed fully.

View Article: PubMed Central - PubMed

Affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.

ABSTRACT

Background: Atrial fibrillation (AF) affects around 2% of the population and early detection is beneficial, allowing patients to begin potentially life-saving anticoagulant therapies. Blood pressure (BP) monitors may offer an opportunity to screen for AF.

Aim: To identify and appraise studies which report the diagnostic accuracy of automated BP monitors used for opportunistic AF detection.

Methods: A systematic search was performed of the MEDLINE, MEDLINE In-Process and EMBASE literature databases. Papers were eligible if they described primary studies of the evaluation of a BP device for AF detection, were published in a peer-reviewed journal and reported values for the sensitivity and specificity. Included studies were appraised using the QUADAS-2 tool to assess their risk of bias and applicability to opportunistic AF detection. Values for the sensitivity and specificity of AF detection were extracted from each paper and compared.

Results and conclusions: We identified seven papers evaluating six devices from two manufacturers. Only one study scored low risk in all of the QUADAS-2 domains. All studies reported specificity >85% and 6 reported sensitivity >90%. The studies showed that BP devices with embedded algorithms for detecting arrhythmias show promise as screening tools for AF, comparing favourably with manual pulse palpation. But the studies used different methodologies and many were subject to potential bias. More studies are needed to more precisely define the sensitivity and specificity of opportunistic screening for AF during BP measurement before its clinical utility in the population of interest can be assessed fully.

No MeSH data available.


Related in: MedlinePlus