Key result
A PPG smartphone app detects AF with ~91% accuracy, rivaling handheld single-lead ECGs.
Why the study?
Important questions remained concerning the diagnostic accuracy, robustness, and device-independent nature of PPG-based pulse-deriving smartphone applications for AF screening.
Does a PPG-based pulse-deriving smartphone application accurately detect atrial fibrillation compared to a 12-lead ECG in cardiology patients?
Cross-Sectional (n=164)
Does a PPG-based pulse-deriving smartphone application accurately detect atrial fibrillation compared to a 12-lead ECG in cardiology patients?
Absolute Event Rate: 90.9% vs 88.9%
A PPG-based smartphone application provides high specificity and moderate sensitivity for detecting atrial fibrillation, though its accuracy is significantly reduced by the presence of regular atrial flutter.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It's fascinating to see the impact that PPG technology is having on clinical practice. Using digital tools in a very structured way enables us to outpace any other traditional methodology to screen or prescreen patients and guide them into an appropriate care pathway. Using digital technology only, we were able to reach a large population very quickly and collect clinically meaningful and actionable data, without the need for medical infrastructure. Patients also benefit by having the flexibility to take measurements anytime, anywhere, and at a fraction of the cost.”
May support smartphone PPG screening in cardiology settings with ECG confirmation; leaves open prospective validation in broader populations.
Background Smartphone applications using photoplethysmography (PPG) technology through their camera are becoming an attractive alternative for atrial fibrillation (AF) screening due to their low cost, convenience, and broad accessibility. However, some important questions concerning their diagnostic accuracy, robustness and device independent nature remain to be answered. Purpose This study evaluated the diagnostic accuracy of a PPG-based pulse-deriving smartphone application with respect to handheld single-lead ECG and 12-lead ECG. In addition, the device dependent nature and robustness of the performance of the application was assessed. Methods 300 Patients who are scheduled for a regular consultation or procedure (i.e. ablation or cardioversion) will be recruited from the cardiology ward. Additionally, patients hospitalized for continuous cardiac monitoring will be recruited to enrich the database with AF measurements. After obtaining written informed consent, the patients fill in a questionnaire collecting demographic and medical information. The pulse-deriving application will be tested on total of 14 different smartphones, 7 iOS devices and 7 Android devices. In total, each device will be measured with 150 times. The patients will additionally perform a single-lead ECG measurement with a handheld device. Subsequently, a 12-lead ECG will be recorded to obtain the reference diagnosis. Results A total of 164 patients already participated in the study. The mean age was 64 (±19) years, 58% was male. The AF-prevalence was 37%. On average, patients in AF had a higher CHA2DS2-VASc score; 3.93 (±1.80) compared to 2.02 (±1.63) for non-AF patients. The amount of insufficient quality measurements recorded with the pulse-deriving smartphone application ranged from 4% (iOS) to 13% (Android). Averaged for all the smartphone devices, the pulse-deriving application scored 81.2% (±5%) sensitivity, 97.1% (±1%) specificity, 88.8% (±2%) NPV, 95.0% (±1%) PPV, and 90.9% (±2%) accuracy. The handheld single-lead ECG device had 78.2% sensitivity, 95.5% specificity, 87.6% NPV, 91.5% PPV, and 88.9% accuracy. The same calculations were preformed after excluding regular atrial flutter measurements. On average, the pulse-deriving application scored 90.1% (±2%) sensitivity, 97.1% (±1%) specificity, 95.2% (±1%) NPV, 94.0% (±1%) PPV, and 94.8% (±1%) accuracy. The handheld single-lead ECG device had 90.2% sensitivity, 97.7% specificity, 97.7% NPV, 95.1% PPV, and 96.9% accuracy. Conclusion The diagnostic accuracy of the pulse-deriving smartphone application and the handheld single-lead ECG device was strongly influenced by the presence of regular atrial flutters, stressing the importance of further thorough validation. For the pulse-deriving smartphone application, there was no significant influence from device type in terms of diagnostic accuracy for the detection of AF. Insufficient quality measurements were more frequently performed on Android devices.
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Proesmans et al. (2019) conducted a cross-sectional in Atrial fibrillation (n=164). PPG-based pulse-deriving smartphone application vs. Handheld single-lead ECG and 12-lead ECG was evaluated on Diagnostic accuracy for atrial fibrillation. A PPG-based smartphone application achieved 90.9% accuracy for detecting atrial fibrillation, compared to 88.9% for a handheld single-lead ECG, though performance was affected by atrial flutter.
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