Kearley Karen, Selwood Mary, Van den Bruel Ann, Thompson Matthew, Mant David, Hobbs Fd Richard, Fitzmaurice David, Heneghan Carl
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BMJ Open. 2014 May 2;4(5):e004565. doi: 10.1136/bmjopen-2013-004565.
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.
6 General Practices in the UK.
1000 ambulatory patients aged 75 years and over.
Comparative diagnostic accuracy of modified BP monitor and single-lead ECG devices, compared to reference standard of 12-lead ECG, independently interpreted by cardiologists.
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.
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.
新型电子设备为在常规基层医疗环境中改善心房颤动（AF）的检测提供了契机，心房颤动是一种常见的心律失常，也是可改变的中风风险因素。我们旨在评估一种改良血压（BP）监测仪和两种单导联心电图设备作为检测AF的诊断分流测试的性能。
英国的6家全科诊所。
1000名75岁及以上的门诊患者。
与由心脏病专家独立解读的12导联心电图参考标准相比，改良BP监测仪和单导联心电图设备的比较诊断准确性。
共有79名参与者（7.9%）通过12导联心电图诊断为AF。所有三种设备都具有较高的敏感性（93.9 - 98.7%），有助于排除AF。WatchBP作为分流测试比欧姆龙自动分析更好，因为它更具特异性，分别为89.7%（95%可信区间87.5%至91.6%）和78.3%（95%可信区间73.0%至82.9%）。在研究人群中，这将转化为较低的后续心电图率，用于确诊/排除AF的比例为17%，而欧姆龙短信提示的比例为29.7%。心脏病专家分析的单导联心电图的总体特异性，欧姆龙为94.6%，梅林为90.1%。
作为基层医疗中识别AF的分流测试，WatchBP比单导联心电图监测仪表现更好，因为它不需要专业解读，其诊断性能与心脏病专家分析的单导联心电图相当。它可用于定期和/或在测量血压时，对老年患者进行机会性筛查，以发现未诊断的AF。
