Opportunistic detection of atrial fibrillation using blood pressure monitors: a systematic review

Abstract

BackgroundAtrial fibrillation (AF) affects around 2% of the population and early detection is beneficial, allowing patients to begin potentially life-saving anticoagulant therapies. Blood pressure (BP) monitors may offer an opportunity to screen for AF.AimTo identify and appraise studies which report the diagnostic accuracy of automated BP monitors used for opportunistic AF detection.MethodsA systematic search was performed of the MEDLINE, MEDLINE In-Process and EMBASE literature databases. Papers were eligible if they described primary studies of the evaluation of a BP device for AF detection, were published in a peer-reviewed journal and reported values for the sensitivity and specificity. Included studies were appraised using the QUADAS-2 tool to assess their risk of bias and applicability to opportunistic AF detection. Values for the sensitivity and specificity of AF detection were extracted from each paper and compared.Results and ConclusionsWe identified seven papers evaluating six devices from two manufacturers. Only one study scored low risk in all of the QUADAS-2 domains. All studies reported specificity >85% and 6 reported sensitivity >90%. The studies showed that BP devices with embedded algorithms for detecting arrhythmias show promise as screening tools for AF, comparing favourably with manual pulse palpation. But the studies used different methodologies and many were subject to potential bias. More studies are needed to more precisely define the sensitivity and specificity of opportunistic screening for AF during BP measurement before its clinical utility in the population of interest can be assessed fully.

Heart Rate Variability: An Old Metric with New Meaning in the Era of using mHealth Technologies for Health and Exercise Training Guidance. Part One: Physiology and Methods

“…A wide range of ambulatory medical and fitness devices are available that use sensors to detect heartbeats. These have been based on sensors for auscultation of the heart (sound), blood pressure measurement (pressure or oscillographic), 13 Guidelines on how to optimise the use of these data need refining.…”

Screening for Atrial Fibrillation During Automatic Blood Pressure Measurements

“…This literature reports sensitivity/specificity combinations of 96%/83%, 93%/89% and 100%/92% for various devices and measurement protocols [11] , [12] . Kane et al [13] undertook a recent systematic review of the area. In previously reported work by our group, Afib detection algorithms were evaluated for suprasystolic oscillometric waveforms from a third commercially available device and yielded similar results [14] .…”

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

“…Two RCTs involved only individuals without a previous diagnosis of AF. 81,83 Three RCTs each evaluated systematic population screening 19,40,82 and systematic opportunistic screening, 19,79,82 one RCT evaluated systematic targeted screening directly, 83 and one RCT evaluated systematic targeted screening indirectly by using results from those individuals identified at 'high risk' among those randomised to systematic population screening. 19 Screening tests employed across the RCTs were mainly pulse palpation and ECG with AF diagnosis predominantly by ECG.…”

“…One reported the accuracy of methods for detecting an irregular pulse and suspected AF; 77 the other reported the accuracy of methods for diagnosing AF using 12-lead ECG. 78 In addition, a systematic review of the DTA of automated blood pressure monitors for opportunistic AF detection, 79 and a review and meta-analysis of the DTA of the algorithm for AF detection during automated blood pressure measurement 80 have been published. These reviews are summarised in Table 7.…”