Validation of a simple method for atrial fibrillation screening in patients with stroke

Balestrino, Maurizio; Bruno, Chiara; Finocchi, Cinzia; Reale, Nicoletta

doi:10.1007/s10072-015-2231-0

Cited by 22 publications

(21 citation statements)

References 22 publications

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“…The specificity of an AF detection algorithm of home BP monitor values was 80% to 90% in earlier studies, and false‐positive readings were observed. In the present study, the accuracy of IHD at IPP20 was 100% in three measurements.…”

Section: Discussionmentioning

confidence: 89%

“…After their report, several reports about the detection of paroxysmal AF by home BP monitors have been published. The sensitivity values were near or equal to 100%, but the specificity values were 80% to 90%, and the agreement between pulse rate and heart rate was not examined simultaneously. In the present study, we confirmed the correlation between the interval of the pulse wave and QRS wave, and we evaluated a new algorithm for the detection of AF by a home BP monitor.…”

Section: Introductionmentioning

confidence: 97%

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Diagnostic accuracy of a new algorithm to detect atrial fibrillation in a home blood pressure monitor

Kabutoya

Imai

Hoshide

2017

J of Clinical Hypertension

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The authors evaluated a new algorithm for detecting atrial fibrillation (AF) using a home blood pressure monitor. Three serial blood pressure values were measured by the monitor in 16 patients with AF and 20 patients with sinus rhythm. The authors defined "monitor AF in irregular pulse peak (IPP) 25" as follows: (1) IPP: |interval of pulse peak − the average of the interval of the pulse peak| ≥ the average of the interval of the pulse peak ×25%; (2) irregular heart beat: beats of IPP ≥ total pulse ×20%; and (3) monitor AF: two or more irregular heart beats of the three blood pressure measurements. Cutoff IPP values were set at 20% (IPP20) and 15% (IPP15). The monitor's AF specificity was 1.0 in IPP25, IPP20, and IPP15, and its sensitivity was 0.88 in IPP25, 0.94 in IPP20, and 1.0 in IPP15. The new algorithm had high diagnostic accuracy for detecting AF and a low false-positive rate. | INTRODUCTIONAtrial fibrillation (AF) is not only a major risk factor for stroke, it also causes heart failure and cardiovascular death.1-4 AF is a common disease and the prevalence of AF increases with age. 2,[5][6][7] Patients with paroxysmal AF have a stroke risk that is similar to that of patients with persistent AF. 8 However, paroxysmal AF is often not detected by standard 12-lead electrocardiography (ECG), as was shown both in patients who have undergone pacemaker implantation 9 and those with cryptogenic stroke who have received an implantable loop recorder. 10Pulse self-examination is useful to detect AF, 11 but paroxysmal AF is often asymptomatic. 12Hypertension is an important risk factor for the onset of AF. 13The causes of the onset of AF are an increase in the stress of the left atrium and autonomic nervous abnormality. 14,15 An increase in the afterload caused by hypertension causes left atrial hypertrophy and fibrosis, which are related to AF. It has been shown that a reduction in blood pressure (BP) results in a decrease in the incidence of AF. 16Two studies revealed that home BP had a higher predictive value for cardiovascular events than office BP. the specificity values were 80% to 90%, 21-24 and the agreement between pulse rate and heart rate was not examined simultaneously. In the present study, we confirmed the correlation between the interval of the pulse wave and QRS wave, and we evaluated a new algorithm for the detection of AF by a home BP monitor. | METHODS | PatientsWe enrolled 16 patients with AF and 20 outpatients with sinus rhythm. Findings from the ECG showed AF during all three BP measurements in the patients with AF and showed sinus rhythm during all three measurements in the 20 patients with sinus rhythm. | Pulse wave analysis and ECGFor each patient, three BP measurements were taken after the patient had rested for ≥5 minutes in the lying position and with at least 30 seconds between measurements, using a validated home BP monitor (UA-1020, A&D). 25 The three BPs were measured by cuff inflation to

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 97%

Diagnostic accuracy of a new algorithm to detect atrial fibrillation in a home blood pressure monitor

Kabutoya

Imai

Hoshide

2017

J of Clinical Hypertension

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“…The reported sensitivity and specificity were approximately 80-100% and 89-99%, respectively (table 6). 3662637172737475…”

Section: Newer Detection Methodsmentioning

confidence: 99%

Newer technologies for detection of atrial fibrillation

Zungsontiporn

Link

2018

BMJ

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Atrial fibrillation is a common arrhythmia that is associated with increased risk of stroke, which can be reduced with appropriate anticoagulation treatment. However, it remains underdiagnosed in contemporary clinical practice using conventional detection methods, resulting in missed opportunities to implement appropriate treatment. Newer technologies developed in recent years can potentially enhance the detection of atrial fibrillation and overcome certain limitations of the conventional methods. However, uncertainties remain about their use and the significance of atrial fibrillation detected by some of these newer technologies. This review examines the evidence supporting the use of some of these technologies and evaluates their applications in certain clinical scenarios.

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“…Several other studies investigated BP monitors with an algorithm similar to the abovementioned modified algorithm and showed similar accuracy in the detection of AF, except one monitor that had a sensitivity of 30% . In general, these BP monitors had higher sensitivity and specificity in the detection of AF.…”

Section: Studies On the Diagnostic Accuracy Of Automated Blood Pressumentioning

confidence: 98%

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”

Chen

Lei

Wang

2017

J of Clinical Hypertension

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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

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Validation of a simple method for atrial fibrillation screening in patients with stroke

Cited by 22 publications

References 22 publications

Diagnostic accuracy of a new algorithm to detect atrial fibrillation in a home blood pressure monitor

Diagnostic accuracy of a new algorithm to detect atrial fibrillation in a home blood pressure monitor

Newer technologies for detection of atrial fibrillation

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”

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