Atrial Fibrillation Screening During Routine Automated Office, Home, and Ambulatory Blood Pressure Measurement: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis

Abstract

BACKGROUND: Atrial fibrillation (AF) is often asymptomatic and undiagnosed. As AF and hypertension often coexist, opportunistic AF detection during routine automated blood pressure (BP) measurement appears to be an attractive screening method. METHODS: A systematic literature search was conducted to identify studies assessing the diagnostic test accuracy of office, home, or 24-hour ambulatory BP measuring devices with AF detection algorithms versus reference electrocardiography. Analyses were performed per participant (AF status based on several BP readings; most office/home devices) or per reading (AF status based on individual readings; all ambulatory devices). A meta-analysis stratified by device type (office/home/ambulatory) was conducted to calculate pooled measures of diagnostic accuracy. Sensitivity/meta-regression analyses were also performed. RESULTS: Among 3096 records initially retrieved, 23 diagnostic test accuracy studies were included. Data derived from 11 093 individuals (weighted age 69 years, males 56%, hypertensives 79%, diabetics 24%, and AF prevalence 17%) indicated a pooled sensitivity 0.97 (95% CI, 0.92–0.99), specificity 0.93 (95% CI, 0.90–0.95), and accuracy 0.93 (95% CI, 0.89–0.95), with generally consistent results using office, home, or ambulatory BP devices (slightly lower specificity with the latter). The positive and negative predictive values were 0.70 (95% CI, 0.60–0.80) and 0.99 (95% CI, 0.98–1.00), respectively. Sensitivity analyses indicated lower specificity in studies implementing reading versus participant analyses. Most studies presented a low risk of bias and minor applicability concerns. CONCLUSIONS: There is considerable and consistent evidence suggesting high diagnostic accuracy of AF detection algorithms implemented in automated BP monitors during routine BP measurements in and out of the office. AF diagnosis requires verification (electrocardiography) before treatment is administered.

To Screen or Not to Screen for Atrial Fibrillation in Patients With Hypertension, That Is Not the Question

“…The integration of AF detection algorithms into various blood pressure (BP) monitors presents an appealing, cost-effective screening option with significant potential. In this issue of Hypertension, Kyriakoulis et al 5 present a systematic review and meta-analysis of studies assessing the diagnostic accuracy of AF detection algorithms integrated into automated oscillometric cuff-based BP monitors designed for office, home, or 24-hour ambulatory monitoring versus AF detected by ECG. The authors conducted 2 types of analyses.…”

“…8,9 This raises questions about the impact of AF screening using BP monitors on the prevention of poor outcomes related to AF. Therefore, while the findings by Kyriakoulis et al 5 are valuable, their study calls for further research focusing on the effect of AF screening on AF-related outcomes.…”