Key result
Automated blood pressure measurement using the Microlife device accurately detected atrial fibrillation with a pooled sensitivity of 0.98 (95% CI 0.95-1.00) and specificity of 0.92 (95% CI 0.88-0.96).
Why the study?
Does automated blood pressure measurement with a specific algorithm accurately detect atrial fibrillation during routine screening?
Meta-Analysis (n=2,332)
Does automated blood pressure measurement with a specific algorithm accurately detect atrial fibrillation during routine screening?
Automated blood pressure measurement with a specific algorithm provides high sensitivity and specificity for opportunistic atrial fibrillation screening, supporting its use in routine practice.
Answers are grounded in this paper and cite their sources.
Supports integration of AF detection into routine automated BP monitoring; strengthens evidence for opportunistic screening.
Several guidelines recommend opportunistic screening for atrial fibrillation (AF) in subjects aged ≥ 65 years using pulse palpation during routine blood pressure (BP) measurement. However, this method has limited diagnostic accuracy. A specific algorithm for AF detection during automated BP measurement was developed and implemented in a novel oscillometric device (Microlife WatchBP Home-A). In 2013, the UK National Institute for Health and Care Excellence (NICE) recommended this device for AF screening during routine office BP measurement in primary care in subjects ≥ 65 years. A review and meta-analysis of the evidence on the diagnostic accuracy of this algorithm were performed. Six studies (n=2332) investigated the accuracy of AF detection using the Microlife BP monitor and estimated a pooled sensitivity at 0.98 (95% CI 0.95, 1.00) and specificity 0.92 (0.88, 0.96). Analysis of 4 studies (n=1126) showed more readings to improve specificity (from 0.86 to 0.91) and sensitivity (from 0.97 to 0.99). Taking 3 sequential readings with at least 2 detecting AF gave the highest diagnostic accuracy. A single study (n=139) of paroxysmal AF screening with home BP monitoring (3316 days) showed sensitivity 99% and specificity 93%. Another study (n=46) of AF screening with 24h ambulatory BP monitoring showed that AF detected in >15% of all readings has high probability of AF diagnosis requiring confirmation by 24h electrocardiography. AF detection with routine automated BP measurement is a reliable screening tool in the elderly, which requires confirmation by electrocardiography. Paroxysmal AF might also be detected by routine automated home or ambulatory BP monitoring.
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Verberk et al. (2015) conducted a meta-analysis in Atrial fibrillation (n=2,332). Automated blood pressure measurement with AF detection algorithm (Microlife WatchBP Home-A) vs. Electrocardiography (reference standard) was evaluated on Diagnostic accuracy (sensitivity and specificity) for AF detection (Sensitivity 0.98, 95% CI 0.95-1.00). Automated blood pressure measurement using the Microlife device accurately detected atrial fibrillation with a pooled sensitivity of 0.98 (95% CI 0.95-1.00) and specificity of 0.92 (95% CI 0.88-0.96).
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