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Triage tests for identifying atrial fibrillation in primary care : a diagnostic accuracy study comparing single-lead ECG and modified BP monitors
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Kearley, Karen, Selwood, Mary, Van den Bruel, Ann, Thompson, Matthew, Mant, David, Hobbs, F. D. Richard, Fitzmaurice, David and Heneghan, Carl (2014) Triage tests for identifying atrial fibrillation in primary care : a diagnostic accuracy study comparing single-lead ECG and modified BP monitors. BMJ Open, 4 (5). e004565. doi:10.1136/bmjopen-2013-004565 ISSN 2044-6055.
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Official URL: http://dx.doi.org/10.1136/bmjopen-2013-004565
Abstract
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.
Item Type: | Journal Article | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | BMJ Open | ||||||
Publisher: | BMJ | ||||||
ISSN: | 2044-6055 | ||||||
Official Date: | 2 May 2014 | ||||||
Dates: |
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Volume: | 4 | ||||||
Number: | 5 | ||||||
Article Number: | e004565 | ||||||
DOI: | 10.1136/bmjopen-2013-004565 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) |
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