Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
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Published on: February 14, 2022
Lærke Marius Kvist1, Nicklas Vinter1,2, Grazina Urbonaviciene1,2
1Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark.
Insights
Single-lead ECG by radiographers showed moderate accuracy for atrial fibrillation (AF) detection, while 12-lead ECG by nurses was highly accurate. This suggests 12-lead ECG by nurses is a viable method for diagnosing AF.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Atrial fibrillation (AF) is a common arrhythmia requiring accurate diagnosis.
- Screening for AF in older populations can improve health outcomes.
- Evaluating the diagnostic performance of different ECG leads and healthcare professionals is crucial.
Purpose of the Study:
- To compare the diagnostic accuracy of single-lead ECG interpreted by radiographers versus 12-lead ECG interpreted by cardiac nurses for detecting atrial fibrillation (AF).
Main Methods:
- A population-based, cross-sectional study of 1338 men aged 65-74 years was conducted.
- Participants underwent single-lead ECG during CT scans (assessed by radiographers) and 12-lead ECG (assessed by cardiac nurses).
- Diagnostic accuracy was benchmarked against 12-lead ECGs interpreted by two cardiologists.
Main Results:
- Single-lead ECG by radiographers had 60.3% sensitivity and 97.2% specificity for AF detection.
- 12-lead ECG by cardiac nurses demonstrated 97.1% sensitivity and 100% specificity for AF.
- Positive predictive value for single-lead ECG was 53.9%, while for 12-lead ECG it was 100%.
Conclusions:
- Single-lead ECG by radiographers offers high specificity and NPV but moderate sensitivity and PPV for AF screening.
- 12-lead ECG by cardiac nurses shows excellent diagnostic accuracy for AF detection.
- 12-lead ECG interpreted by cardiac nurses is a promising method for diagnosing atrial fibrillation.
Aim:
We examined the diagnostic accuracy of single-lead ECG as assessed by radiographers and 12-lead ECG as assessed by cardiac nurses for the diagnosis of atrial fibrillation (AF).
Methods:
Based on the Danish Cardiovascular Screening Trial, we conducted a population-based, cross-sectional study of 1338 randomly selected Danish men aged 65-74 years with no exclusion criteria. The participants were screened with single-lead ECG during a CT scan assessed by radiographers and 12-lead ECG assessed by cardiac nurses. The diagnostic accuracy was evaluated compared with that produced by a 12-lead ECG assessed by two consenting cardiologists.
Results:
The study identified 68 participants with ongoing AF, of whom 60 had self-reported AF and 8 had AF detected in the screening. Single-lead ECG assessed for AF by radiographers had a sensitivity of 60.3% (95% CI 47.7 to 72.0), specificity of 97.2% (95% CI 96.2 to 98.1), positive predictive value (PPV) of 53.9% (95% CI 42.1 to 65.5) and negative predictive value (NPV) of 97.9% (95% CI 96.9 to 98.6). 12-lead ECG assessed by cardiac nurses had a sensitivity of 97.1% (95% CI 89.8 to 99.6), specificity of 100% (95% CI 99.7 to 100), PPV of 100% (95% CI 94.6 to 100) and NPV of 99.8% (95% CI 99.4 to 100).
Conclusions:
Single-lead ECG assessed by radiographers had a moderate sensitivity and PPV but a very high specificity and NPV. Using radiographers may be acceptable for opportunistic screening, in particular if radiographers are thoroughly trained. Thus, 12-lead ECG assessed by cardiac nurses is a potential diagnostic method for the detection of AF.
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