What does this research mean for the field?

Blood pressure monitors and non-12-lead ECGs are the most accurate methods for detecting pulse irregularities caused by atrial fibrillation, outperforming standard pulse palpation. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine and compare the diagnostic accuracy of various methods for detecting pulse irregularities caused by suspected atrial fibrillation against standard 12-lead electrocardiography.

October 13, 2015European Journal of Preventive CardiologyOpen Access

Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: A systematic review and meta-analysis

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Why the study?

Are blood pressure monitors, non-12-lead ECGs, and smartphone applications accurate for detecting pulse irregularities caused by atrial fibrillation compared to 12-lead ECG?

Population

21 studies investigating 39 interventions (n = 15,129 pulse assessments) for detecting atrial fibrillation

Comparison

Methods for detecting pulse irregularities… vs 12-lead electrocardiography diagnosed atrial…

Design

Meta-analysis

Authors

JTJaspal TaggarUniversity of Nottingham TCTim ColemanHuman Genome Sciences (United States)SLSarah LewisFlorida State University

Discussion

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Implication

Supports blood pressure monitors and non-12-lead ECGs for initial AF screening; confirms high diagnostic accuracy versus 12-lead ECG.

Key Points

To determine and compare the diagnostic accuracy of various methods for detecting pulse irregularities caused by suspected atrial fibrillation against standard 12-lead electrocardiography.
Systematically searched MEDLINE, EMBASE, CINAHL, and LILACS through March 16, 2015, evaluating study quality using the QUADAS-2 instrument.
Analyzed 21 studies assessing 39 screening interventions across 15,129 pulse evaluations using a bivariate hierarchical random-effects meta-analysis.
Blood pressure monitors showed a sensitivity of 0.98 (95% CI 0.92–1.00), specificity of 0.92 (95% CI 0.88–0.95), positive likelihood ratio (PLR) of 12.1 (95% CI 8.2–17.8), and negative likelihood ratio (NLR) of 0.02 (95% CI 0.00–0.09).
Non-12-lead ECGs yielded a sensitivity of 0.91 (95% CI 0.86–0.94), specificity of 0.95 (95% CI 0.92–0.97), PLR of 20.1 (95% CI 12.0–33.7), and NLR of 0.09 (95% CI 0.06–0.14).
Manual pulse palpation demonstrated lower diagnostic accuracy, with a sensitivity of 0.92 (95% CI 0.85–0.96), specificity of 0.82 (95% CI 0.76–0.88), PLR of 5.2 (95% CI 3.8–7.2), and NLR of 0.10 (95% CI 0.05–0.18).

Structured PICO

Are blood pressure monitors, non-12-lead ECGs, and smartphone applications accurate for detecting pulse irregularities caused by atrial fibrillation compared to 12-lead ECG?

Population

21 studies investigating 39 interventions (n = 15,129 pulse assessments) for detecting atrial fibrillation

Intervention

Methods for detecting pulse irregularities caused by atrial fibrillation (blood pressure monitors, non-12-lead ECGs, smartphone applications, pulse palpation)

Comparator

12-lead electrocardiography (ECG) diagnosed atrial fibrillation

Outcome

Accuracy (sensitivity, specificity, positive and negative likelihood ratios) for detecting pulse irregularities attributable to atrial fibrillationsurrogate

Blood pressure monitors and non-12-lead ECGs are highly accurate for detecting pulse irregularities caused by atrial fibrillation and may be pragmatic alternatives to pulse palpation for initial screening.

Limitations

Smartphone application studies were small in size

Cite This Study

Taggar et al. (2015) studied this question.

synapsesocial.com/papers/6a1bd730d54006be995f174b https://doi.org/10.1177/2047487315611347

Topics

Atrial fibrillation Persistent AF management

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Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: A systematic review and meta-analysis

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: A systematic review and meta-analysis

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

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