Sensitivity and specificity of automated blood pressure devices to detect atrial fibrillation: A systematic review and meta-analysis of diagnostic accuracy

Abstract

BackgroundAtrial fibrillation (AF) is a prevalent and preventable cause of stroke and mortality.AimThis systematic review and meta-analysis aimed to investigate the sensitivity and specificity of office and out-of-office automated blood pressure (BP) devices to detect AF.MethodsDiagnostic studies, extracted from databases such as Ovid Medline and Embase, on AF detection by BP device(s), electrocardiography, and reported sensitivity and specificity, were included. Screening of abstracts and full texts, data extraction, and quality assessment were conducted independently by two investigators using Covidence software. The sensitivity and specificity of the BP devices were pooled using a random-effects model.ResultsSixteen studies including 10,158 participants were included. Only a few studies were conducted in primary care (n = 3) or with a low risk of bias (n = 5). Office BP devices, which utilised different algorithms to detect AF, had a sensitivity and specificity of 96.2 and 94%, respectively. Specificity was reduced when only one positive result was considered among consecutive BP measurements. Only a few studies (n = 3) investigated out-of-office BP. Only one study (n = 100) suggested the use of ≥79 and ≥26% of positive readings on 24-h ambulatory BP measurements to detect AF and paroxysmal AF, respectively.ConclusionsOffice BP devices can be used clinically to screen for AF in high-risk populations. Clinical trials are needed to determine the effect of AF screening using office BP devices in reducing stroke risk and mortality. Further studies are also required to guide out-of-office use of BP devices for detecting paroxysmal AF or AF.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022319541, PROSPERO CRD42022319541.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…In addition, despite the methodological limitations, both auscultation and automated oscillatory BP measurements have prognostic value in AF patients and can thus be used for office measurements, while only the automated oscillatory method can be used for home and ambulatory BP assessment [127,1174]. Recently, specific algorithms for accurately detecting AF during BP measurements [105,[1174][1175][1176][1177][1178] have been included in automated oscillatory BP monitors. This may increase the potential for an extended AF detection because a large fraction of AF episodes is asymptomatic [1163,1164].…”

Atrial Fibrillation Detection and Management in Hypertension

“…In meta-analysis of 16 studies, including 10 158 participants, office BP devices (n=13 studies), which utilized different algorithms to detect AF, had a sensitivity of 96 [92-98]% and specificity of 94 [91-96]%. 22 Only a few studies (n=3) investigated ambulatory/home BP monitors for AF detection with sensitivity and specificity of 76% to 93% and 81% to 98%, respectively. 22 Most importantly, according to the current AF guidelines, a single-lead electrocardiogram recording of ≥30 seconds or a 12-lead electrocardiogram of an AF episode is still required to establish a definitive diagnosis of AF.…”

“…22 Only a few studies (n=3) investigated ambulatory/home BP monitors for AF detection with sensitivity and specificity of 76% to 93% and 81% to 98%, respectively. 22 Most importantly, according to the current AF guidelines, a single-lead electrocardiogram recording of ≥30 seconds or a 12-lead electrocardiogram of an AF episode is still required to establish a definitive diagnosis of AF. 12…”

“…In meta-analysis of 16 studies, including 10 158 participants, office BP devices (n=13 studies), which utilized different algorithms to detect AF, had a sensitivity of 96 [92–98]% and specificity of 94 [91–96]%. 22 Only a few studies (n=3) investigated ambulatory/home BP monitors for AF detection with sensitivity and specificity of 76% to 93% and 81% to 98%, respectively. 22…”

“…22 Only a few studies (n=3) investigated ambulatory/home BP monitors for AF detection with sensitivity and specificity of 76% to 93% and 81% to 98%, respectively. 22…”