Atrial fibrillation screening during automated blood pressure measurement—Comment on “Diagnostic accuracy of new algorithm to detect atrial fibrillation in a home blood pressure monitor”

Abstract

With the increasing longevity and prevalence of cardiovascular disease, such as hypertension and chronic heart failure, there is an emerging epidemic of atrial fibrillation (AF) in almost all communities.According to the worldwide estimation in 2010, the prevalence of AF was 0.596% in men and 0.373% in women, and the estimated number of patients with AF worldwide was 33.5 million. Several models of BP monitors from various manufacturers were developed with an added function of irregular heartbeat detection (Table). [11][12][13][14][15][16][17] Some of those devices were tested for accuracy in the detection of AF. Wiesel and colleagues 11,13,15 have conducted a series of studies on AF detection during BP measurement. In a pioneering study, Wiesel and associates 11 used an algorithm for the detection of AF during BP measurement on the basis of the last 10 pulses during cuff deflation. The irregularity index was defined as the standard deviation of the time intervals between successive heartbeats divided by the mean of the intervals. In a validation study against a standard 12-lead ECG, an irregularity index of 0.06 or greater was used as the threshold for the diagnosis of AF. 11 This algorithm was integrated in a home BP monitor (modified Omron 712C, Omron). In 450 outpatients including 54 with AF diagnosed by ECG, the diagnostic sensitivity was 100% and specificity was 84% during a single BP measurement. 11 The false-positive results were mainly seen in patients with frequent ectopic beats. 11 The investigators then modified the algorithm by discarding pulse intervals of 25% shorter or 25% longer than the average and using the remaining time intervals for the calculation of the irregularity index. In a later study in 405 patients including 93 with AF diagnosed by ECG, the newer algorithm with a single BP measurement had a sensitivity and specificity of 95% and 86%, respectively. 13 When three measurements were performed with at least two of the three indicating AF, the sensitivity and specificity rates were 97% and 89%, respectively.13

Newer technologies for detection of atrial fibrillation

“…Automatic oscillometric blood pressure monitors with algorithms for detecting atrial fibrillation detect atrial fibrillation by checking the regularity of pulses 70. The Microlife BP monitor (Microlife USA, Dunedin, FL) is one of the best studied devices.…”

2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

“…One device identifies possible AF when at least two of three consecutive measurements show pulse irregularity. Several studies addressed the diagnostic accuracy 51,68,71‐77 and the feasibility of this device as a screening tool 51,75,78 …”

“…Blood pressure (BP) measurements can be erratic when the pulse is irregular. This characteristic is utilized by automatic oscillometric BP monitors that derive heart rhythm regularity algorithmically 68 . Automated BP monitors have been used for opportunistic AF detection.…”

2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

“…Blood pressure (BP) measurements can be erratic when the pulse is irregular. This characteristic is utilized by automatic oscillometric BP monitors that derive heart rhythm regularity algorithmically (Chen, Lei, & Wang, 2017). Automated BP monitors have been used for opportunistic AF detection.…”

“…One device identifies possible AF when at least two of three consecutive measurements show pulse irregularity. Several studies addressed the diagnostic accuracy , Chen, Lei, & Wang, 2017, Gandolfo, Balestrino, Bruno, Finocchi, & Reale, 2015, Kearley et al, 2014, Marazzi et al, 2012, Stergiou, Karpettas, Protogerou, Nasothimiou, & Kyriakidis, 2009, Wiesel, Fitzig, Herschman, & Messineo, 2009, Wiesel, Arbesfeld, & Schechter, 2014 and the feasibility of this device as a screening tool , Omboni & Verberk, 2016, Wiesel & Salomone, 2017.…”