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Published on: February 26, 2013
Screening for Atrial Fibrillation During Automatic Blood Pressure Measurements
Andrew Lowe1, Timothy H Oh2, Ralph Stewart3
1Institute of Biomedical Technologies, Auckland University of TechnologyAuckland1010New Zealand.
Insights
Screening for atrial fibrillation (Afib) using oscillometric devices shows high accuracy. This method offers a cost-effective approach for detecting Afib in primary care settings, improving cardiovascular risk management.
Area of Science:
- Cardiology
- Biomedical Engineering
- Health Economics
Background:
- Atrial fibrillation (Afib) is a major contributor to cardiovascular risk.
- Current Afib screening via palpation lacks accuracy and relies on clinician skill.
- Oscillometric algorithms show promise for Afib detection, but factors influencing accuracy require further study.
Purpose of the Study:
- To evaluate the accuracy of oscillometric algorithms for detecting atrial fibrillation.
- To investigate factors influencing the sensitivity and specificity of Afib detection using oscillometry.
- To assess the health-economic benefits of oscillometric Afib screening in primary care.
Main Methods:
- Concurrent electrocardiogram (ECG) and oscillometry measurements were obtained from 569 participants.
- Root mean squared successive difference (RMSSD) and irregularity index (Irrx) were calculated from oscillometric data.
- Logistic regression classifiers were trained and validated using Monte Carlo cross-validation.
Main Results:
- RMSSD and Irrx demonstrated high sensitivity (0.982-0.986) and specificity (0.908-0.960) for Afib detection.
- Excluding ectopics improved specificity by up to 5%.
- The study suggests a positive net health-economic benefit for oscillometric Afib screening in individuals over 60.
Conclusions:
- Oscillometric devices can accurately screen for atrial fibrillation, offering an improvement over manual palpation.
- Factors like ectopics and repeated measurements influence detection accuracy.
- Widespread adoption of oscillometric Afib screening in primary care is recommended for improved patient outcomes and cost-effectiveness.
Abstract:
Atrial fibrillation (Afib) contributes significantly to overall cardiovascular risk. Widespread screening for Afib in primary care is sometimes performed by palpation, but suffers from low accuracy and is dependent on clinician experience. Algorithms implemented on oscillometric blood pressure devices can detect Afib with high sensitivity and specificity, but information on factors affecting accuracy is scant. Concurrent diagnostic electrocardiogram (ECG) and oscillometry were measured in participants in ECG clinics at two sites. Root mean squared successive difference (RMSSD) and irregularity index (Irrx) were calculated from oscillometric data and used to train logistic regression classifiers. Monte Carlo cross validation with 20 splits was performed to estimate confidence intervals for mean sensitivity and specificity, with various weightings, in the absence or presence of ectopics, and with or without repeated measurements. 707 measurements, including 168 Afib, were collected from 569 participants with mean (standard deviation) age of 63 (16) years. Sensitivity/specificity of RMSSD and Irrx were 0.982/0.908 and 0.986/0.960 respectively when ectopics were included. Excluding ectopics from the data improved specificity by up to 5%. Nevertheless, based on this performance and after accounting for prevalence of Afib in the population aged over 60 years, and estimated costs of healthcare, oscillometric screening for Afib in this age group could return a positive net health-economic benefit.
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