Diagnostic accuracy of an oscillometric blood pressure monitor for atrial fibrillation screening

Abstract

Objective Atrial fibrillation is the most common arrhythmia of clinical significance and hypertension is one of its major risk factors. This study aimed to evaluate the diagnostic accuracy of an automated oscillometric blood pressure (BP) monitor with the function of atrial fibrillation detection for atrial fibrillation screening. Materials and methods Patients attending outpatient cardiology clinics were recruited for atrial fibrillation screening by the BP monitor with triplicate BP measurements for atrial fibrillation detection. Furthermore, a single-lead ECG was recorded simultaneously for comparison as the reference standard. The diagnostic test’s evaluation index were analyzed, including sensitivity, specificity, and receiver operator characteristic (ROC) analysis. Results A total of 295 participants were analyzed including 166 males and 129 females, with an average age of 72.5 ± 5.9 years. The sensitivity and specificity for atrial fibrillation detection by the device were 1.000 and 0.904, respectively, with the area under the ROC curve of 0.952 (95% confidence interval: 0.929–0.975, P < 0.001). Furthermore, the device had a Kappa-value of 0.781 (P < 0.001) with the single-lead ECG in detecting atrial fibrillation. Conclusion The automated oscillometric BP monitor (G.LAB MD41A0) with atrial fibrillation detection function has high sensitivity and specificity with good accuracy for atrial fibrillation screening, which could be used as a reliable screening tool for the early detection of atrial fibrillation with potential benefits.

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.…”

“…The AF detection accuracy was assessed using office, home, and ambulatory devices in 2, 22,25 18, 17,18,20,21,23,26,[28][29][30][31][32][33][34][35][36][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][18][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][29][30][31][32][33][34][35]…”

“…31,33,35,37 Twelve studies used Microlife BP measuring devices, 22,23,[28][29][30][31][32][33][34][35][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.…”

“…18 Details about the measurement methodology, AF definition, and the analysis implemented in each study are shown in Table S1. Fifteen studies used 12-lead ECG, 18,[20][21][22]26,28,[30][31][32][34][35][36][37] 5 single-lead ECG, 17,23,25,29,33 and the rest (the studies of ambulatory devices) used 24-hour Holter ECG 19,27 or pacemaker monitoring 24 as the reference method. Thirteen studies implemented the reference method simultaneously with BP measurement, [17][18][19][20][22][23][24][25][26][27]34,36 while the rest shortly before/after.…”

“…Fifteen studies used 12-lead ECG, 18,[20][21][22]26,28,[30][31][32][34][35][36][37] 5 single-lead ECG, 17,23,25,29,33 and the rest (the studies of ambulatory devices) used 24-hour Holter ECG 19,27 or pacemaker monitoring 24 as the reference method. Thirteen studies implemented the reference method simultaneously with BP measurement, [17][18][19][20][22][23][24][25][26][27]34,36 while the rest shortly before/after. Most studies used the participant analysis approach, and only 4 (including the 3 devices for ambulatory use) performed a reading analysis as their main analysis.…”