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New electronic devices offer an opportunity within routine primary care settings for improving the detection of atrial fibrillation AFwhich 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. Comparative diagnostic accuracy of modified BP monitor and single-lead ECG devices, compared to reference standard of lead ECG, independently interpreted by cardiologists.
A total of 79 omroh 7. All three devices hct-801 a high sensitivity WatchBP is a better triage test than Omron autoanalysis because it is more specific— The overall specificity of single-lead ECGs analysed by hxg-801 cardiologist was 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.
A large evidence base supports the efficacy of oral anticoagulation in reducing AF stroke gcg-801 by two-thirds. Despite this, it was found to be undiagnosed in 3. European guidelines for the management of AF recommended opportunistic pulse assessment by a primary care practitioner with a follow-up ECG for an irregular pulse, an approach which is more cost-effective than systematic screening with a lead ECG.
Although pulse examination is a simple screening technique for AF, its detection relies on a subjective assessment in a busy routine care setting, which may hfg-801 explain why AF remains undetected in many patients. Indeed the American Heart Association suggests there is a need to develop strategies to detect AF more effectively in individuals and populations.
Several new electronic devices have the potential to be useful triage tests for AF and initial studies suggest these have higher specificity than pulse palpation, so could significantly reduce the need for confirmatory lead ECGs—but none have been evaluated in a primary care setting. Having excluded patients with implanted pacemakers or defibrillators, those unable to give informed consent, or patients in whom the general practitioner GP considered participation was inappropriate eg, terminal illnessall other patients over 75 were invited to take part until the sample size had been achieved ie, participants had been recruited.
A diagnosis of AF recorded in the patient GP record was not used as part of the selection criteria. All participants received the tests in the same order, which were delivered by nine registered nurses working within the practices. First, the nurse used WatchBP Microlife, Switzerland a modified oscillometric BP monitor which flashes when it detects an irregular pulse during automatic BP measurement.
The monitor records a single-lead ECG tracing, and displays a message indicating the presence of possible AF. The device’s analysis algorithm includes several cardiac rhythms which could potentially be AF, including fast and irregular, slow and irregular, irregular and those where analysis is impossible. The single-lead recording and text message were recorded and saved for later downloading and analysis. The recording, with no automated analysis, was saved to a computer for later downloading and analysis.
Unlike the Omron, the Merlin monitor does not require removal of any clothing, making it possible for use in public settings, an advantage for participants experiencing an intermittent arrhythmia. The nurse recorded the results of the WatchBP monitor chg-801 the Omron automated text message during the initial examination.
Each single-lead ECG trace was sent for interpretation to two independent cardiologists after removing all clinical information and patient identification except for date of birth and the text message Omron only.
Omron HeartScan HCG-801 Package
A lead ECG was performed on all participants lmron the end of the visit, using standard procedures. ECGs were independently interpreted by a panel of two cardiologists, blind to all patient identifiers, clinical details, results of triage tests, but not blind to study objectives. A third cardiologist, also blind to any of the other study results, interpreted the ECG readings for which there was no consensus or if both cardiologists were uncertain about the presence of AF.
To cope with the workload, the task was divided between two separate pairs of cardiologists. The third cardiologist, whose role was to resolve uncertainty and moderate disagreement, was a specialist electrophysiologist. All inconclusive results were treated as positive in our analysis because in the clinical situation these participants could not have AF ruled out and would need to have a lead ECG. Analyses for both single-lead ECGs were carried out per cardiologist and the results were subsequently combined using a random effects bivariate model calculating overall sensitivity and specificity.
We performed subset analyses of the comparative accuracy in patients with and without existing diagnoses of AF whether or not treated recorded in GP records. In addition, we modelled a two-stage screening process for AF by examining patients who were WatchBP flash positive and analysing the sensitivity and specificity of the Omron autoanalysis in this subgroup.
Of potentially eligible patients, we invited for a screening visit; no further invitations were sent after the required sample had been achieved figure 1.
Participants had an average age of AF was noted in a further 12 participants based on the lead ECG 1. The three cardiologists could not reach a consensus about whether AF was present in the lead ECG in one participant, who was therefore excluded from further analyses which are therefore based on participants.
Of these, 16 were already known, and three were new cases of AF. Both WatchBP and Omron autoanalysis were highly sensitive The specificity of Hcg-081 was Diagnostic performance of WatchBP and Omron autoanalysis for detecting atrial fibrillation.
Omron Hcg-801 Portable Cordless ECG Heart Monitor
The superior sensitivity of the Omron text message means the false negative rate is lower than with Watch BP 0. The prevalence of AF was 1. We modelled a two-stage screening process within our total sample, where patients who had a positive result with WatchBP went on to have the Omron autoanalysis. The diagnostic accuracy of the Omron and Merlin single-lead ECGs is shown in figure 3 ; meta-analysis of the four cardiologist’s interpretations gave Omron a summary sensitivity of Cardiologist variability in single-lead ECG analysis is shown in table 3.
The cardiologists were unable to interpret whether the trace showed AF on 0—1. Our results show that all the methods that we tested have a high sensitivity for detecting AF in an elderly primary care population and thus are useful for ruling out AF. During the study we detected 12 new cases of AF and 7. WatchBP hcv-801 Omron autoanalysis because it is more specific— Overall Omron produced fewer inconclusive results and achieved slightly better specificity than Merlin.
However cardiologist interpretation of the ECG trace was a more powerful factor in determining specificity than the type of monitor used. In this study, operator variability in ECG analysis was partly due to differences in expertise, and partly due to trade-offs made by different cardiologists between sensitivity and specificity.
Most of these patients already had a diagnosis of AF. The devices were tested on an unselected elderly primary care population. Although our sample did not include the housebound or patients with dementia, we recruited a large population with a prevalence of AF expected for this setting, which allowed us to determine the operating characteristics of each monitor with precision.
We believe our population is generalisable to similar primary care settings worldwide. The specificity of one cardiologist was substantially lower than the other three. Further research with a larger sample of cardiologists would be required to more fully interpret this finding.
However, we do not believe this diminishes the reliability of our reference standard since the second pair of blinded cardiologists achieved extremely high concordance, and the moderating consultant cardiologist was a specialist electrophysiologist. Having cardiologists rather than GPs ascertain the presence or absence of AF on the Omron or Merlin single-lead ECGs may have risked over estimating accuracy given the likelihood that cardiologists would have greater skill in ECG interpretation.
The operating characteristics of WatchBP in this elderly primary care population are comparable to previous studies undertaken in different populations.
We are unaware of any AF validation studies for Merlin. Specificity is comparable with a single-lead ECG analysed by a cardiologist and the imron does not require specialist interpretation, which is an advantage over the single-lead ECG monitors and keeps screening straightforward and costs less.
It is easily portable for use in housebound patients. Prior to wider implementation, clinicians need to consider the optimal screening frequency. As some patients have their BP measured frequently, there is potential for recurrent false positive results and a high demand for lead ECGs. These issues should be addressed to ensure sustainable implementation in primary care. Paroxysmal AF presents a particular diagnostic challenge because patients may not be experiencing an arrhythmia when they are being screened with one-off measures.
The potential for patients to undertake self-monitoring and jcg-801 capture an ECG tracing when an arrhythmia is occurring are desirable features of an AF screening method.
WatchBP will not identify atrial flutter, which is also a risk factor for stroke. The prevalence of this is much omdon than AF; in our study it was 0. Screening for AF is not yet routine practice in primary care, therefore determining not only the optimal device, but also the most appropriate and cost-effective process is a priority. This could include an impact analysis using WatchBP as a triage test to evaluate its effectiveness and cost-effectiveness for improving the detection of AF and prevention of stroke.
Determining the cost-effectiveness of these devices would also have to include doctor time for interpretation of ECGs. WatchBP performs omfon than the single-lead ECG monitors as a triage test for identifying AF in primary care as it does not require any expertise for interpretation and their diagnostic performance is comparable.
It has advantages over pulse assessment because the result is objective and it also has a higher specificity, keeping follow-up lead ECGs to a minimum. MS oversaw data management and monitoring of protocol adherence throughout the omro. Provenance and peer review: Not commissioned; externally peer reviewed. Data on comparative omfon are available from authors on request, sending email to the corresponding author. National Center for Biotechnology InformationU.
Published hc-801 Apr Author information Article notes Copyright and License information Disclaimer.
Correspondence to Dr Matthew Thompson; ude. For permission to use where not already granted under a licence please go to http: This article has been cited by other articles in PMC. Associated Data Supplementary Materials Reviewer comments.
OMRON ECG HEARTSCAN HCG
Abstract Objective New electronic devices offer an opportunity within routine primary care settings for improving the detection of atrial fibrillation AFwhich is a common cardiac arrhythmia and a modifiable risk factor for stroke. Setting o,ron General Practices in the UK. Primary and secondary outcome measures Comparative diagnostic accuracy of modified BP monitor and single-lead ECG devices, compared to reference standard hccg-801 lead ECG, independently interpreted by cardiologists.
Results A total of 79 participants 7. 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.
Primary Care, Stroke Medicine.
Strengths and limitations of this study. Three devices for detecting atrial fibrillation AF were tested omorn an unselected elderly primary care population of individuals. The prevalence of AF expected for this setting, which allowed us to determine the operating characteristics of each monitor with precision. A reference standard lead ECG was performed on all patients, and interpreted blindly by cardiologists.