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

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We evaluated the diagnostic value of atrial fibrillation (AF) measured by a wrist-type pulse wave monitor in this case-control study. Six serial pulse wave values (three in the left and three in the right wrist) were measured using a wrist-type monitor in 29 AF patients and 30 subjects with sinus rhythm. We defined "monitor AF in irregular pulse peak (IPP) 15/20/25" as follows: (a) IPP: |interval of pulse peak − the average of the interval of the pulse peak| ≥ the average of the interval of the pulse peak × 15/20/25%; (b) irregular heartbeat (IHB): beats of IPP ≥ total pulse × 20%; and (c) monitor AF: ≥4 IHBs of the six pulse wave measurements. In IPP 15, the sensitivity and specificity were 0.97 and 1.00, respectively. Pulse wave analysis by a wrist-type monitor was shown to have high sensitivity and specificity for the diagnosis of AF.

Section: Discussionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Diagnostic accuracy of an algorithm for detecting atrial fibrillation in a wrist‐type pulse wave monitor

Kabutoya

Takahashi²,

Watanabe

et al. 2019

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“…In this issue of the Journal, Kabutoya and colleagues reported a new algorithm for the detection of AF using a BP monitor. The authors believe that the new algorithm may further improve accuracy for the detection of AF during BP measurement.…”

Section: Studies On the Diagnostic Accuracy Of Automated Blood Pressumentioning

confidence: 99%

“…The new algorithm was developed from a new angle to improve specificity in the detection of AF. However, cardiac arrhythmias other than AF were not included in this study . Both the current and previous algorithms were designed by assessing pulse rate irregularity.…”

Section: Studies On the Diagnostic Accuracy Of Automated Blood Pressumentioning

confidence: 99%

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

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

“…AF itself is associated with increased risk of stroke and systemic emboli, but patients with both AF and hypertension have a higher risk of stroke compared to those with either condition alone . Thus, earlier detection and treatment of new‐onset AF are essential in patients with hypertension …”

Section: Introductionmentioning

confidence: 99%

Impact of pre‐existing hypertension and control status before atrial fibrillation onset on cardiovascular prognosis in patients with non‐valvular atrial fibrillation: A real‐world database analysis in Japan

Kario

Abe

Kanegae

2019

Self Cite

Hypertension is an important risk factor for non‐valvular atrial fibrillation (NVAF) and its prognosis. However, there is no study to clarify the impact of pre‐existing hypertension and BP control status before the onset of AF on the prognosis after the onset of AF. This retrospective real‐world cohort analysis used data from the Japan Medical Data Center Co., Ltd database. The presence of NVAF and hypertension, plus the occurrence of adverse events, was based on ICD‐10 codes in the database. The primary composite AF‐related cardiovascular event end point included ischemic stroke, hemorrhagic stroke, and acute myocardial infarction. Of the 21 523 patients identified as having new‐onset NVAF between January 2005 and June 2016, 7885 had blood pressure (BP) data before the onset of NVAF available and were included in the analysis (4001 with pre‐existing hypertension and 3884 without pre‐existing hypertension). The rate of primary composite end point events was 10.3 and 4.4 per 1000 patient‐years in patients with and without hypertension, respectively (P < .001). In addition, lower systolic BP (<120 mm Hg) before the onset of NVAF was associated with a lower incidence of cardiovascular events after the development of NVAF (P < .001). This highlights the importance of earlier and tighter 24‐hour BP control before the onset of NVAF in patients with hypertension, not only for reducing the occurrence of new‐onset of NVAF, but also for reducing both hemorrhagic and ischemic cardiovascular events after the onset of NVAF.