Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors. Kearley, K., Selwood, M., Van den Bruel, A., Thompson, M., Mant, D., Hobbs, F. R., Fitzmaurice, D., & Heneghan, C. BMJ Open, 4(5):e004565, April, 2014. ![Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex 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 singlelead 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 singlelead 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.
@article{kearley_triage_2014-1,
title = {Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead {ECG} and modified {BP} monitors},
volume = {4},
issn = {2044-6055, 2044-6055},
shorttitle = {Triage tests for identifying atrial fibrillation in primary care},
url = {http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2013-004565},
doi = {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 singlelead 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 singlelead 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.},
language = {en},
number = {5},
urldate = {2020-05-12},
journal = {BMJ Open},
author = {Kearley, Karen and Selwood, Mary and Van den Bruel, Ann and Thompson, Matthew and Mant, David and Hobbs, FD Richard and Fitzmaurice, David and Heneghan, Carl},
month = apr,
year = {2014},
pages = {e004565},
file = {Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:/Users/neil.hawkins/Zotero/storage/QASMX3QG/Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:application/pdf;Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:/Users/neil.hawkins/Zotero/storage/IWG7GUVQ/Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:application/pdf},
}
Downloads: 0
{"_id":"2zkyefJ4auRgqpWES","bibbaseid":"kearley-selwood-vandenbruel-thompson-mant-hobbs-fitzmaurice-heneghan-triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors-2014","author_short":["Kearley, K.","Selwood, M.","Van den Bruel, A.","Thompson, M.","Mant, D.","Hobbs, F. R.","Fitzmaurice, D.","Heneghan, C."],"bibdata":{"bibtype":"article","type":"article","title":"Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors","volume":"4","issn":"2044-6055, 2044-6055","shorttitle":"Triage tests for identifying atrial fibrillation in primary care","url":"http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2013-004565","doi":"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 singlelead 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 singlelead 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.","language":"en","number":"5","urldate":"2020-05-12","journal":"BMJ Open","author":[{"propositions":[],"lastnames":["Kearley"],"firstnames":["Karen"],"suffixes":[]},{"propositions":[],"lastnames":["Selwood"],"firstnames":["Mary"],"suffixes":[]},{"propositions":["Van","den"],"lastnames":["Bruel"],"firstnames":["Ann"],"suffixes":[]},{"propositions":[],"lastnames":["Thompson"],"firstnames":["Matthew"],"suffixes":[]},{"propositions":[],"lastnames":["Mant"],"firstnames":["David"],"suffixes":[]},{"propositions":[],"lastnames":["Hobbs"],"firstnames":["FD","Richard"],"suffixes":[]},{"propositions":[],"lastnames":["Fitzmaurice"],"firstnames":["David"],"suffixes":[]},{"propositions":[],"lastnames":["Heneghan"],"firstnames":["Carl"],"suffixes":[]}],"month":"April","year":"2014","pages":"e004565","file":"Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:/Users/neil.hawkins/Zotero/storage/QASMX3QG/Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:application/pdf;Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:/Users/neil.hawkins/Zotero/storage/IWG7GUVQ/Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:application/pdf","bibtex":"@article{kearley_triage_2014-1,\n\ttitle = {Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead {ECG} and modified {BP} monitors},\n\tvolume = {4},\n\tissn = {2044-6055, 2044-6055},\n\tshorttitle = {Triage tests for identifying atrial fibrillation in primary care},\n\turl = {http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2013-004565},\n\tdoi = {10.1136/bmjopen-2013-004565},\n\tabstract = {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 singlelead 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 singlelead 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.},\n\tlanguage = {en},\n\tnumber = {5},\n\turldate = {2020-05-12},\n\tjournal = {BMJ Open},\n\tauthor = {Kearley, Karen and Selwood, Mary and Van den Bruel, Ann and Thompson, Matthew and Mant, David and Hobbs, FD Richard and Fitzmaurice, David and Heneghan, Carl},\n\tmonth = apr,\n\tyear = {2014},\n\tpages = {e004565},\n\tfile = {Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:/Users/neil.hawkins/Zotero/storage/QASMX3QG/Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:application/pdf;Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:/Users/neil.hawkins/Zotero/storage/IWG7GUVQ/Kearley et al. - 2014 - Triage tests for identifying atrial fibrillation i.pdf:application/pdf},\n}\n\n","author_short":["Kearley, K.","Selwood, M.","Van den Bruel, A.","Thompson, M.","Mant, D.","Hobbs, F. R.","Fitzmaurice, D.","Heneghan, C."],"bibbaseid":"kearley-selwood-vandenbruel-thompson-mant-hobbs-fitzmaurice-heneghan-triagetestsforidentifyingatrialfibrillationinprimarycareadiagnosticaccuracystudycomparingsingleleadecgandmodifiedbpmonitors-2014","role":"author","urls":{"Paper":"http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2013-004565"},"metadata":{"authorlinks":{}}},"bibtype":"article","biburl":"https://bibbase.org/f/FfNE7kWA6pCvwcJZF/myPubs.bib","dataSources":["ZaHtWavQhcwZqKLNF","iRRNaRs6FkffgErta","v8uQmZsBpiqycmskv"],"keywords":[],"search_terms":["triage","tests","identifying","atrial","fibrillation","primary","care","diagnostic","accuracy","study","comparing","single","lead","ecg","modified","monitors","kearley","selwood","van den bruel","thompson","mant","hobbs","fitzmaurice","heneghan"],"title":"Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors","year":2014}