Handheld ECG devices (MyDiagnostick and AliveCor) for AF screening in hospitalized patients showed suboptimal automated sensitivity (54.5%-89.5%) and specificity (94.2%-97.9%) compared to 12-lead ECG.
Cross-Sectional (n=445)
Blinded
Do handheld single-lead ECG devices accurately and cost-effectively detect atrial fibrillation compared to standard ECG in hospitalized cardiology and geriatric patients?
Handheld ECG devices for AF screening in hospitalized patients require a structured strategy excluding those with implanted devices and known AF, plus targeted 12-lead ECGs to optimize specificity and cost-effectiveness.
To determine the usability, accuracy, and cost-effectiveness of two handheld single-lead electrocardiogram (ECG) devices for atrial fibrillation (AF) screening in a hospital population with an increased risk for AF. Hospitalized patients (n = 445) at cardiological or geriatric wards were screened for AF by two handheld ECG devices (MyDiagnostick and AliveCor). The performance of the automated algorithm of each device was evaluated against a full 12-lead or 6-lead ECG recording. All ECGs and monitor tracings were also independently reviewed in a blinded fashion by two electrophysiologists. Time investments by nurses and physicians were tracked and used to estimate cost-effectiveness of different screening strategies. Handheld recordings were not possible in 7 and 21.4% of cardiology and geriatric patients, respectively, because they were not able to hold the devices properly. Even after the exclusion of patients with an implanted device, sensitivity and specificity of the automated algorithms were suboptimal (Cardiology: 81.8 and 94.2%, respectively, for MyDiagnostick; 54.5 and 97.5%, respectively, for AliveCor; Geriatrics: 89.5 and 95.7%, respectively, for MyDiagnostick; 78.9 and 97.9%, respectively, for AliveCor). A scenario based on automated AliveCor evaluation in patients without AF history and without an implanted device proved to be the most cost-effective method, with a provider cost to identify one new AF patient of €193 and €82 at cardiology and geriatrics, respectively. The cost to detect one preventable stroke per year would be €7535 and €1916, respectively (based on average CHA2DS2-VASc of 3.9 ± 2.0 and 5.0 ± 1.5, respectively). Manual interpretation increases sensitivity, but decreases specificity, doubling the cost per detected patient, but remains cheaper than sole 12-lead ECG screening. Using AliveCor or MyDiagnostick handheld recorders requires a structured screening strategy to be effective and cost-effective in a hospital setting. It must exclude patients with implanted devices and known AF, and requires targeted additional 12-lead ECGs to optimize specificity. Under these circumstances, the expenses per diagnosed new AF patient and preventable stroke are reasonable.
Desteghe et al. (Wed,) conducted a cross-sectional in Atrial fibrillation (n=445). Handheld single-lead ECG devices (MyDiagnostick and AliveCor) vs. Full 12-lead or 6-lead ECG recording was evaluated on Sensitivity and specificity of the automated algorithm against a full 12-lead or 6-lead ECG recording. Handheld ECG devices (MyDiagnostick and AliveCor) for AF screening in hospitalized patients showed suboptimal automated sensitivity (54.5%-89.5%) and specificity (94.2%-97.9%) compared to 12-lead ECG.