BackgroundDiagnosing atrial fibrillation (AF) before ischemic stroke occurs is a priority for stroke prevention in AF. Smartphone camera–based photoplethysmographic (PPG) pulse waveform measurement discriminates between different heart rhythms, but its ability to diagnose AF in real‐world situations has not been adequately investigated. We sought to assess the diagnostic performance of a standalone smartphone PPG application, Cardiio Rhythm, for AF screening in primary care setting.Methods and ResultsPatients with hypertension, with diabetes mellitus, and/or aged ≥65 years were recruited. A single‐lead ECG was recorded by using the AliveCor heart monitor with tracings reviewed subsequently by 2 cardiologists to provide the reference standard. PPG measurements were performed by using the Cardiio Rhythm smartphone application. AF was diagnosed in 28 (2.76%) of 1013 participants. The diagnostic sensitivity of the Cardiio Rhythm for AF detection was 92.9% (95% CI] 77–99%) and was higher than that of the AliveCor automated algorithm (71.4% [95% CI 51–87%]). The specificities of Cardiio Rhythm and the AliveCor automated algorithm were comparable (97.7% [95% CI: 97–99%] versus 99.4% [95% CI 99–100%]). The positive predictive value of the Cardiio Rhythm was lower than that of the AliveCor automated algorithm (53.1% [95% CI 38–67%] versus 76.9% [95% CI 56–91%]); both had a very high negative predictive value (99.8% [95% CI 99–100%] versus 99.2% [95% CI 98–100%]).ConclusionsThe Cardiio Rhythm smartphone PPG application provides an accurate and reliable means to detect AF in patients at risk of developing AF and has the potential to enable population‐based screening for AF.

In this evaluation of PPG waveforms from adults screened for AF in a real-world primary care setting, the DCNN had high sensitivity, specificity, PPV and NPV for detecting AF, outperforming other state-of-the-art methods based on handcrafted features.

No abstract

ObjectiveTo evaluate the diagnostic performance of a UK National Institute for Health and Care Excellence-recommended automatic oscillometric blood pressure (BP) measurement device incorporated with an atrial fibrillation (AF) detection algorithm (Microlife WatchBP Home A) for real-world AF screening in a primary healthcare setting.SettingPrimary healthcare setting in Hong Kong.InterventionsThis was a prospective AF screening study carried out between 1 September 2014 and 14 January 2015. The Microlife device was evaluated for AF detection and compared with a reference standard of lead-I ECG.Primary outcome measuresDiagnostic performance of Microlife for AF detection.Results5969 patients (mean age: 67.2±11.0 years; 53.9% female) were recruited. The mean CHA2DS2-VASc (C: congestive heart failure [1 point]; H: hypertension [1 point]; A2: age 65-74 years [1 point] and age ≥75 years [2 points]; D: diabetes mellitus [1 point]; S: prior stroke or transient ischemic attack [2 points]; VA: vascular disease [1 point]; and Sc: sex category [female] [1 point])score was 2.8±1.3. AF was diagnosed in 72 patients (1.21%) and confirmed by a 12-lead ECG. The Microlife device correctly identified AF in 58 patients and produced 79 false-positives. The corresponding sensitivity and specificity for AF detection were 80.6% (95% CI 69.5 to 88.9) and 98.7% (95% CI 98.3 to 98.9), respectively. Among patients with a false-positive by the Microlife device, 30.4% had sinus rhythm, 35.4% had sinus arrhythmia and 29.1% exhibited premature atrial complexes. With the low prevalence of AF in this population, the positive and negative predictive values of Microlife device for AF detection were 42.4% (95% CI 34.0 to 51.2) and 99.8% (95% CI 99.6 to 99.9), respectively. The overall diagnostic performance of Microlife device to detect AF as determined by area under the curves was 0.90 (95% CI 0.89 to 0.90).ConclusionsIn the primary care setting, Microlife WatchBP Home was an effective means to screen for AF, with a reasonable sensitivity of 80.6% and a high negative predictive value of 99.8%, in addition to its routine function of BP measurement. In a younger patient population aged <65 years with a lower prevalence of AF, Microlife WatchBP Home A demonstrated a similar diagnostic accuracy.

Correspondence 0 429 revealed a characteristic alteration of the ganglion cells with many intracytoplasmic membranous structures which are possibly phospholipids (see Figure). The close morphological resemblance between these inclusions and those described in amaurotic familial idiocy is apparent when comparing the electronmicrograph of a human cerebral ganglionElectronmicrograph of rat ganglion cell from a chloroquine-treated hooded rat (100 mg./kg.daily for 12 months). The cytoplasm contains many membranous structures.cell in Tay-Sachs disease' with our own observation. The striking similarity between the two entities at both the macroscopic and ultrastructural levels suggests the possibility of common features in the pathogenesis of these specific lesions. I should like to comment on those letters as a result of my experience as a psychiatrist working with a paediatric team in a special clinic for severely ill asthmatic children, many of whom are treated with steroids because they have failed to respond to all other forms of treatment. During a three-year period 32 children under 13 years of age received 5 mg. prednisone-twice daily. At the start of our survey I might have been tempted, in agreement with Dr. Dalton, to advocate the early use of steroids in those asthmatic children who showed emotional disturbance, as it was notoriously difficult to get parents to accept psychotherapy for them. The initial response -of the whole group of 32 children on prednisone was excellent, and those children who were obviously emotionally disturbed responded as well as the rest of the group. Physical symptoms abated, reactive anxiety disappeared, and longstanding symptoms of emotional disturbance caused less distress than before treatment. The children were not distressed by sideeffects of prednisone and developed no replacement symptoms.Unfortunately a minority failed to sustain this improvement. Of course, physical determinants are of critical importance, but some categories of psychological disturbance were prominent in the case histories of those who failed to sustain a good response. Eleven out of 32 children became dependent on naintained use of steroids, and five of those were among those whose emotional disturbance appeared to play a decisive role in the severity -of their asthmatic condition. In four other children personality development showed modifications in character organization, often socially acceptable, but clinically disadvantageous when viewed in relationship to the perpetuation of the asthmatic wheeze and its recurrence during steroid withdrawal. It is possible that this group shows most clearly the complexity of relationship between experience of eczema and asthma, psychological modification of the personality, and response to treatment by steroids.Three children subsequently died, including two of these severely emotionally disturbed children. We suspect that all three used aerosols excessively during the period of great anxiety which preceded their death. Hence my interest in Dr. A. Tothill's and ...