دورية أكاديمية
أعرض في EDS

Detection of atrial fibrillation in primary care with radial pulse palpation, electronic blood pressure measurement and handheld single-lead electrocardiography: a diagnostic accuracy study.

التفاصيل البيبلوغرافية
العنوان: Detection of atrial fibrillation in primary care with radial pulse palpation, electronic blood pressure measurement and handheld single-lead electrocardiography: a diagnostic accuracy study.
المؤلفون: Verbiest-van Gurp N; Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands nicole.vangurp@maastrichtuniversity.nl., Uittenbogaart SB; Department of General Practice, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands., Lucassen WAM; Department of General Practice, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands., Erkens PMG; Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands., Knottnerus JA; Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands., Winkens B; Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands., Stoffers HEJH; Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands., van Weert HCPM; Department of General Practice, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands.
المصدر: BMJ open [BMJ Open] 2022 Jun 29; Vol. 12 (6), pp. e059172. Date of Electronic Publication: 2022 Jun 29.
نوع المنشور: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
مواضيع طبية MeSH: Atrial Fibrillation*/diagnosis, Blood Pressure ; Electrocardiography ; Electronics ; Humans ; Mass Screening ; Palpation ; Primary Health Care
مستخلص: Objective: To determine the diagnostic accuracy of three tests-radial pulse palpation, an electronic blood pressure monitor and a handheld single-lead ECG device-for opportunistic screening for unknown atrial fibrillation (AF).
Design: We performed a diagnostic accuracy study in the intention-to-screen arm of a cluster randomised controlled trial aimed at opportunistic screening for AF in general practice. We performed radial pulse palpation, followed by electronic blood pressure measurement (WatchBP Home A) and handheld ECG (MyDiagnostick) in random order. If one or more index tests were positive, we performed a 12-lead ECG at shortest notice. Similarly, to limit verification bias, a random sample of patients with three negative index tests received this reference test. Additionally, we analysed the dataset using multiple imputation. We present pooled diagnostic parameters.
Setting: 47 general practices participated between September 2015 and August 2018.
Participants: In the electronic medical record system of the participating general practices (n=47), we randomly marked 200 patients of ≥65 years without AF. When they visited the practice for any reason, we invited them to participate. Exclusion criteria were terminal illness, inability to give informed consent or visit the practice or having a pacemaker or an implantable cardioverter-defibrillator.
Outcomes: Diagnostic accuracy of individual tests and test combinations to detect unknown AF.
Results: We included 4339 patients; 0.8% showed new AF. Sensitivity and specificity were 62.8% (range 43.1%-69.7%) and 91.8% (91.7%-91.8%) for radial pulse palpation, 70.0% (49.0%-80.6%) and 96.5% (96.3%-96.7%) for electronic blood pressure measurement and 90.1% (60.8%-100%) and 97.9% (97.8%-97.9%) for handheld ECG, respectively. Positive predictive values were 5.8% (5.3%-6.1%), 13.8% (12.2%-14.8%) and 25.2% (24.2%-25.8%), respectively. All negative predictive values were ≥99.7%.
Conclusion: In detecting AF, electronic blood pressure measurement (WatchBP Home A), but especially handheld ECG (MyDiagnostick) showed better diagnostic accuracy than radial pulse palpation.
Trial Registration Number: Netherlands Trial Register No. NL4776 (old NTR4914).
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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فهرسة مساهمة: Keywords: cardiology; pacing & electrophysiology; preventive medicine
تواريخ الأحداث: Date Created: 20220629 Date Completed: 20220701 Latest Revision: 20220716
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC9244719
DOI: 10.1136/bmjopen-2021-059172
PMID: 35768092
قاعدة البيانات: MEDLINE
الوصف
تدمد:2044-6055
DOI:10.1136/bmjopen-2021-059172