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Diagnostic Performance of a Smartphone ‐ Based Photoplethysmographic Application for Atrial Fibrillation Screening in a Primary Care Setting

View Article: PubMed Central - PubMed

ABSTRACT

Background: Diagnosing atrial fibrillation (AF) before ischemic stroke occurs is a priority for stroke prevention in AF. Smartphone camera–based photoplethysmographic (PPG) pulse waveform measurement discriminates between different heart rhythms, but its ability to diagnose AF in real‐world situations has not been adequately investigated. We sought to assess the diagnostic performance of a standalone smartphone PPG application, Cardiio Rhythm, for AF screening in primary care setting.

Methods and results: Patients with hypertension, with diabetes mellitus, and/or aged ≥65 years were recruited. A single‐lead ECG was recorded by using the AliveCor heart monitor with tracings reviewed subsequently by 2 cardiologists to provide the reference standard. PPG measurements were performed by using the Cardiio Rhythm smartphone application. AF was diagnosed in 28 (2.76%) of 1013 participants. The diagnostic sensitivity of the Cardiio Rhythm for AF detection was 92.9% (95% CI] 77–99%) and was higher than that of the AliveCor automated algorithm (71.4% [95% CI 51–87%]). The specificities of Cardiio Rhythm and the AliveCor automated algorithm were comparable (97.7% [95% CI: 97–99%] versus 99.4% [95% CI 99–100%]). The positive predictive value of the Cardiio Rhythm was lower than that of the AliveCor automated algorithm (53.1% [95% CI 38–67%] versus 76.9% [95% CI 56–91%]); both had a very high negative predictive value (99.8% [95% CI 99–100%] versus 99.2% [95% CI 98–100%]).

Conclusions: The Cardiio Rhythm smartphone PPG application provides an accurate and reliable means to detect AF in patients at risk of developing AF and has the potential to enable population‐based screening for AF.

No MeSH data available.


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jah31595-fig-0002: Study enrollment and flow.

Mentions: Between May and June 2015, 1098 patients who fulfilled the inclusion criteria of the present study were invited to participate in the AF screening study; 72 (6.5%) declined. Of the consenting patients, 12 were excluded from the final analysis because of failure to complete the screening process, and 1 patient was excluded because the ECG tracings were uninterpretable by the cardiologists. As a result, 1013 patients were included in this study (Figure 2). Table 1 summarizes the characteristics of the study population. The mean age was 68.4±12.2 years; 474 (46.8%) patients were male. Hypertension was present in 916 (90.4%) patients, and diabetes mellitus was present in 371 (36.6%). In addition, there were 164 (16.2%) patients with coronary artery disease and 106 (10.5%) patients with a history of previous stroke. The mean CHA2DS2‐VASc score was 3.0±1.5.


Diagnostic Performance of a Smartphone ‐ Based Photoplethysmographic Application for Atrial Fibrillation Screening in a Primary Care Setting
Study enrollment and flow.
© Copyright Policy - creativeCommonsBy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015379&req=5

jah31595-fig-0002: Study enrollment and flow.
Mentions: Between May and June 2015, 1098 patients who fulfilled the inclusion criteria of the present study were invited to participate in the AF screening study; 72 (6.5%) declined. Of the consenting patients, 12 were excluded from the final analysis because of failure to complete the screening process, and 1 patient was excluded because the ECG tracings were uninterpretable by the cardiologists. As a result, 1013 patients were included in this study (Figure 2). Table 1 summarizes the characteristics of the study population. The mean age was 68.4±12.2 years; 474 (46.8%) patients were male. Hypertension was present in 916 (90.4%) patients, and diabetes mellitus was present in 371 (36.6%). In addition, there were 164 (16.2%) patients with coronary artery disease and 106 (10.5%) patients with a history of previous stroke. The mean CHA2DS2‐VASc score was 3.0±1.5.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Diagnosing atrial fibrillation (AF) before ischemic stroke occurs is a priority for stroke prevention in AF. Smartphone camera–based photoplethysmographic (PPG) pulse waveform measurement discriminates between different heart rhythms, but its ability to diagnose AF in real‐world situations has not been adequately investigated. We sought to assess the diagnostic performance of a standalone smartphone PPG application, Cardiio Rhythm, for AF screening in primary care setting.

Methods and results: Patients with hypertension, with diabetes mellitus, and/or aged ≥65 years were recruited. A single‐lead ECG was recorded by using the AliveCor heart monitor with tracings reviewed subsequently by 2 cardiologists to provide the reference standard. PPG measurements were performed by using the Cardiio Rhythm smartphone application. AF was diagnosed in 28 (2.76%) of 1013 participants. The diagnostic sensitivity of the Cardiio Rhythm for AF detection was 92.9% (95% CI] 77–99%) and was higher than that of the AliveCor automated algorithm (71.4% [95% CI 51–87%]). The specificities of Cardiio Rhythm and the AliveCor automated algorithm were comparable (97.7% [95% CI: 97–99%] versus 99.4% [95% CI 99–100%]). The positive predictive value of the Cardiio Rhythm was lower than that of the AliveCor automated algorithm (53.1% [95% CI 38–67%] versus 76.9% [95% CI 56–91%]); both had a very high negative predictive value (99.8% [95% CI 99–100%] versus 99.2% [95% CI 98–100%]).

Conclusions: The Cardiio Rhythm smartphone PPG application provides an accurate and reliable means to detect AF in patients at risk of developing AF and has the potential to enable population‐based screening for AF.

No MeSH data available.