WatchBP Home A for Opportunistically Detecting Atrial Fibrillation During Diagnosis and Monitoring of Hypertension: A NICE Medical Technology Guidance

Willits, Iain; Keltie, Kim; Craig, Joyce; Sims, Andrew

doi:10.1007/s40258-014-0096-7

Cited by 53 publications

(42 citation statements)

References 30 publications

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“…The cost‐effectiveness of such a solution would require a proper clinical evaluation. The first evidence for pulse‐based AF screening in stroke prevention programs has been provided for an oscillometric blood pressure device38 able to automatically determine pulse irregularity that may be caused by AF 39…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation Detection Using a Novel Cardiac Ambulatory Monitor Based on Photo‐Plethysmography at the Wrist

Bonomi

Schipper

Eerikäinen

et al. 2018

JAHA

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BackgroundLong‐term continuous cardiac monitoring would aid in the early diagnosis and management of atrial fibrillation (AF). This study examined the accuracy of a novel approach for AF detection using photo‐plethysmography signals measured from a wrist‐based wearable device.Methods and Results ECG and contemporaneous pulse data were collected from 2 cohorts of AF patients: AF patients (n=20) undergoing electrical cardioversion (ECV) and AF patients (n=40) that were prescribed for 24 hours ECG Holter in outpatient settings (HOL). Photo‐plethysmography and acceleration data were collected at the wrist and processed to determine the inter‐pulse interval and discard inter‐pulse intervals in presence of motion artifacts. A Markov model was deployed to assess the probability of AF given irregular pattern in inter‐pulse interval sequences. The AF detection algorithm was evaluated against clinical rhythm annotations of AF based on ECG interpretation. Photo‐plethysmography recordings from apparently healthy volunteers (n=120) were used to establish the false positive AF detection rate of the algorithm. A total of 42 and 855 hours (AF: 21 and 323 hours) of photo‐plethysmography data were recorded in the ECV and HOL cohorts, respectively. AF was detected with >96% accuracy (ECV, sensitivity=97%; HOL, sensitivity=93%; both with specificity=100%). Because of motion artifacts, the algorithm did not provide AF classification for 44±16% of the monitoring period in the HOL group. In healthy controls, the algorithm demonstrated a <0.2% false positive AF detection rate.ConclusionsA novel AF detection algorithm using pulse data from a wrist‐wearable device can accurately discriminate rhythm irregularities caused by AF from normal rhythm.

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation Detection Using a Novel Cardiac Ambulatory Monitor Based on Photo‐Plethysmography at the Wrist

Bonomi

Schipper

Eerikäinen

et al. 2018

JAHA

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“…This identified 261 records, of which eight papers [99][100][101][102][103][104][105][106] not previously identified were considered relevant after title and abstract screening and a further four papers [107][108][109][110] were highlighted as providing information on costs.…”

Section: Outcomes Of the Economic Evaluationmentioning

confidence: 99%

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

118

116

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BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources.ObjectivesTo conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model.DesignSystematic review, meta-analysis and cost-effectiveness analysis.SettingPrimary care.ParticipantsAdults.InterventionScreening strategies, defined by screening test, age at initial and final screens, screening interval and format of screening {systematic opportunistic screening [individuals offered screening if they consult with their general practitioner (GP)] or systematic population screening (when all eligible individuals are invited to screening)}.Main outcome measuresSensitivity, specificity and diagnostic odds ratios; the odds ratio of detecting new AF cases compared with no screening; and the mean incremental net benefit compared with no screening.Review methodsTwo reviewers screened the search results, extracted data and assessed the risk of bias. A DTA meta-analysis was perfomed, and a decision tree and Markov model was used to evaluate the cost-effectiveness of the screening strategies.ResultsDiagnostic test accuracy depended on the screening test and how it was interpreted. In general, the screening tests identified in our review had high sensitivity (> 0.9). Systematic population and systematic opportunistic screening strategies were found to be similarly effective, with an estimated 170 individuals needed to be screened to detect one additional AF case compared with no screening. Systematic opportunistic screening was more likely to be cost-effective than systematic population screening, as long as the uptake of opportunistic screening observed in randomised controlled trials translates to practice. Modified blood pressure monitors, photoplethysmography or nurse pulse palpation were more likely to be cost-effective than other screening tests. A screening strategy with an initial screening age of 65 years and repeated screens every 5 years until age 80 years was likely to be cost-effective, provided that compliance with treatment does not decline with increasing age.ConclusionsA national screening programme for AF is likely to represent a cost-effective use of resources. Systematic opportunistic screening is more likely to be cost-effective than systematic population screening. Nurse pulse palpation or modified blood pressure monitors would be appropriate screening tests, with confirmation by diagnostic 12-lead electrocardiography interpreted by a trained GP, with referral to a specialist in the case of an unclear diagnosis. Implementation strategies to operationalise uptake of systematic opportunistic screening in primary care should accompany any screening recommendations.LimitationsMany inputs for the economic model relied on a single trial [the Screening for Atrial Fibrillation in the Elderly (SAFE) study] and DTA results were based on a few studies at high risk of bias/of low applicability.Future workComparative studies measuring long-term outcomes of screening strategies and DTA studies for new, emerging technologies and to replicate the results for photoplethysmography and GP interpretation of 12-lead electrocardiography in a screening population.Study registrationThis study is registered as PROSPERO CRD42014013739.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…It is part of a series of NICE Medical Technology Guidance summaries being published in Applied Health Economics and Health Policy under the remit of NICE’s Medical Technology Evaluation Programme (MTEP) [1–4]. …”

Section: Introductionmentioning

confidence: 99%

EXOGEN Ultrasound Bone Healing System for Long Bone Fractures with Non-Union or Delayed Healing: A NICE Medical Technology Guidance

Higgins

Glover

Yang

et al. 2014

Appl Health Econ Health Policy

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A routine part of the process for developing National Institute for Health and Care Excellence (NICE) medical technologies guidance is a submission of clinical and economic evidence by the technology manufacturer. The Birmingham and Brunel Consortium External Assessment Centre (EAC; a consortium of the University of Birmingham and Brunel University) independently appraised the submission on the EXOGEN bone healing system for long bone fractures with non-union or delayed healing. This article is an overview of the original evidence submitted, the EAC’s findings, and the final NICE guidance issued.

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WatchBP Home A for Opportunistically Detecting Atrial Fibrillation During Diagnosis and Monitoring of Hypertension: A NICE Medical Technology Guidance

Cited by 53 publications

References 30 publications

Atrial Fibrillation Detection Using a Novel Cardiac Ambulatory Monitor Based on Photo‐Plethysmography at the Wrist

Atrial Fibrillation Detection Using a Novel Cardiac Ambulatory Monitor Based on Photo‐Plethysmography at the Wrist

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

EXOGEN Ultrasound Bone Healing System for Long Bone Fractures with Non-Union or Delayed Healing: A NICE Medical Technology Guidance

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