Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring in ICU patients from a large real-world database

Abstract

Objectives: Oscillometric blood pressure (BP) measurement in atrial fibrillation patients is controversial due to stroke volume variation. Here, we performed a cross-sectional study to investigate the impact of atrial fibrillation on the accuracy of oscillometric BP in the ICU setting.Methods: Adult patients with atrial fibrillation or sinus rhythm records were enrolled from Medical Information Mart for Intensive Care-III database. Concurrently recorded noninvasive oscillometric BPs (NIBPs) and intra-arterial BPs (IBPs) were classified as atrial fibrillation or sinus rhythm group according to heart rhythm. Bland-Altmann plots assessed bias and limits of agreement of NIBP to IBP. Pairwise comparison was performed on NIBP/IBP bias between atrial fibrillation and sinus rhythm. Linear mixedeffect model was used to assess the impact of heart rhythm on NIBP/IBP bias after adjusting confounders.Results: Two thousand, three hundred and thirty-five patients (71.95 AE 11.23 years old, 60.90% were men) were included. Systolic, diastolic, and mean NIBP/IBP biases were not clinically different between atrial fibrillation and sinus rhythm circumstances (SBP bias: 0.66 vs. 1.21 mmHg, P ¼ 0.002; DBP: À5.29 vs. À5.17, P ¼ 0.1; mean BP: À4.45 vs. À4.19, P ¼ 0.01). After adjusting for age, sex, heart rate, arterial BP, and vasopressor usage, the effect of heart rhythm on NIBP/IBP bias was within AE5 mmHg for SBP and DBP [effect on SBP bias: 3.32 mmHg (95% confidence interval (CI) 2.89-3.74), P < 0.001; DBP: À0.89 (À1.17 to À0.60), P < 0.001], while the effect on mean BP bias was not significant [0.18 mmHg (À0.10 to 0.46), P ¼ 0.2].Conclusion: Atrial fibrillation would not influence the agreement of oscillometric BP to IBP in ICU patients compared with sinus rhythm.

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

“…Among 3096 articles initially retrieved, 21 DTA reports including 23 DTA studies fulfilled the inclusion criteria and were included in the systematic review and meta-analysis. 17–37 Two reports included 2 studies each. 31,34 The main characteristics of the included studies are summarized in Table 1.…”

“…31,34 The main characteristics of the included studies are summarized in Table 1. The AF detection accuracy was assessed using office, home, and ambulatory devices in 2, 22,25 18, 17,18,20,21,23,26,28–37 and 3 studies, 19,24,27 respectively. Ten studies were conducted in Europe, 20,22,24,27,28,30,32,34,36 8 in Asia, 17–19,21,23,25,26,29 and the rest 5 in the United States.…”

“…The AF detection accuracy was assessed using office, home, and ambulatory devices in 2, 22,25 18, 17,18,20,21,23,26,28–37 and 3 studies, 19,24,27 respectively. Ten studies were conducted in Europe, 20,22,24,27,28,30,32,34,36 8 in Asia, 17–19,21,23,25,26,29 and the rest 5 in the United States. 31,33,35,37 Twelve studies used Microlife BP measuring devices, 22,23,28–36 6 used Omron devices 20,21,25,31,34,37 (1 study with an AF detector implemented by the investigators on an Omron device 37 ), and 2 used A&D devices.…”

“…31,33,35,37 Twelve studies used Microlife BP measuring devices, 22,23,28–36 6 used Omron devices 20,21,25,31,34,37 (1 study with an AF detector implemented by the investigators on an Omron device 37 ), and 2 used A&D devices. 19,23 Grandway, 17 Nissei, 18 and Ostar 26 BP devices were used in 1 study each. All devices were automated oscillometric upper arm cuff devices, except for the Nissei WS-X10J which was a wrist cuff BP monitor.…”

Blood Pressure: The History and Development of Monitoring Modalities

“…24 MAP correlates directly with maximum oscillations and is accepted as the most accurate value derived from NIBP devices. 24 NIBP devices are not recommended for use in patients with arrythmias that impact stroke volume, such as atrial fibrillation, 23,24,27 because of an erratic MAP with stroke volume variation that results in inaccurate device performance. Unfortunately, very few interprofessional clinicians are aware of this fact, leading to continued use of NIBP in patients with atrial fibrillation which leads to highly invalid and unreliable BP measurement.…”