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]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},
}

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