A prediction model using 24-hour ECG data demonstrated good discrimination for detecting atrial fibrillation on extended monitoring (ROC 0.7497; 95% CI 0.7336-0.7659).
Observational (n=18,220)
Yes
Can a prediction model based on 24-hour ambulatory ECG data predict the detection of atrial fibrillation on extended cardiac monitoring in patients without AF on the first day?
A prediction model using initial 24-hour ECG data can identify a low-risk group (20% of patients) in whom extended monitoring for atrial fibrillation may be safely avoided.
Effect estimate: ROC statistic 0.7497 (95% CI 0.7336-0.7659)
BACKGROUND: Access to long-term ambulatory recording to detect atrial fibrillation (AF) is limited for economical and practical reasons. We aimed to determine whether 24 h ECG (24hECG) data can predict AF detection on extended cardiac monitoring. METHODS: We included all US patients from 2020, aged 17-100 years, who were monitored for 2-30 days using the PocketECG device (MEDICALgorithmics), without AF ≥30 s on the first day (n = 18,220, mean age 64.4 years, 42.4% male). The population was randomly split into equal training and testing datasets. A Lasso model was used to predict AF episodes ≥30 s occurring on days 2-30. RESULTS: The final model included maximum heart rate, number of premature atrial complexes (PACs), fastest rate during PAC couplets and triplets, fastest rate during premature ventricular couplets and number of ventricular tachycardia runs ≥4 beats, and had good discrimination (ROC statistic 0.7497, 95% CI 0.7336-0.7659) in the testing dataset. Inclusion of age and sex did not improve discrimination. A model based only on age and sex had substantially poorer discrimination, ROC statistic 0.6542 (95% CI 0.6364-0.6720). The prevalence of observed AF in the testing dataset increased by quintile of predicted risk: 0.4% in Q1, 2.7% in Q2, 6.2% in Q3, 11.4% in Q4, and 15.9% in Q5. In Q1, the negative predictive value for AF was 99.6%. CONCLUSION: By using 24hECG data, long-term monitoring for AF can safely be avoided in 20% of an unselected patient population whereas an overall risk of 9% in the remaining 80% of the population warrants repeated or extended monitoring.
Johnson et al. (Fri,) conducted a observational in Atrial fibrillation (n=18,220). 24-hour ECG data prediction model vs. Age and sex-based model was evaluated on AF episodes ≥30 s occurring on days 2-30 (ROC statistic 0.7497, 95% CI 0.7336-0.7659). A prediction model using 24-hour ECG data demonstrated good discrimination for detecting atrial fibrillation on extended monitoring (ROC 0.7497; 95% CI 0.7336-0.7659).