Head-to-Head Comparison of the AliveCor Heart Monitor and Microlife WatchBP Office AFIB for Atrial Fibrillation Screening in a Primary Care Setting
2016; Lippincott Williams & Wilkins; Volume: 135; Issue: 1 Linguagem: Inglês
10.1161/circulationaha.116.024439
ISSN1524-4539
AutoresPak‐Hei Chan, Chun‐Ka Wong, Louise Pun, Yu‐Fai Wong, Michelle Man‐Ying Wong, Daniel Wai‐Sing Chu, Chung‐Wah Siu,
Tópico(s)Cardiac Imaging and Diagnostics
ResumoHomeCirculationVol. 135, No. 1Head-to-Head Comparison of the AliveCor Heart Monitor and Microlife WatchBP Office AFIB for Atrial Fibrillation Screening in a Primary Care Setting Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBHead-to-Head Comparison of the AliveCor Heart Monitor and Microlife WatchBP Office AFIB for Atrial Fibrillation Screening in a Primary Care Setting Pak-Hei Chan, MBBS, Chun-Ka Wong, MBBS, Louise Pun, BA, Yu-Fai Wong, MBBS, Michelle Man-Ying Wong, MBBS, Daniel Wai-Sing Chu, MBBS and Chung-Wah Siu, MD Pak-Hei ChanPak-Hei Chan From Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (P.-H.C., C.-K.W); and Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hong Kong SAR, China (L.P., Y.-F.W., M.M.-Y.W., D.W.-S.C.). , Chun-Ka WongChun-Ka Wong From Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (P.-H.C., C.-K.W); and Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hong Kong SAR, China (L.P., Y.-F.W., M.M.-Y.W., D.W.-S.C.). , Louise PunLouise Pun From Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (P.-H.C., C.-K.W); and Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hong Kong SAR, China (L.P., Y.-F.W., M.M.-Y.W., D.W.-S.C.). , Yu-Fai WongYu-Fai Wong From Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (P.-H.C., C.-K.W); and Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hong Kong SAR, China (L.P., Y.-F.W., M.M.-Y.W., D.W.-S.C.). , Michelle Man-Ying WongMichelle Man-Ying Wong From Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (P.-H.C., C.-K.W); and Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hong Kong SAR, China (L.P., Y.-F.W., M.M.-Y.W., D.W.-S.C.). , Daniel Wai-Sing ChuDaniel Wai-Sing Chu From Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (P.-H.C., C.-K.W); and Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hong Kong SAR, China (L.P., Y.-F.W., M.M.-Y.W., D.W.-S.C.). and Chung-Wah SiuChung-Wah Siu From Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China (P.-H.C., C.-K.W); and Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hong Kong SAR, China (L.P., Y.-F.W., M.M.-Y.W., D.W.-S.C.). Originally published3 Jan 2017https://doi.org/10.1161/CIRCULATIONAHA.116.024439Circulation. 2017;135:110–112The diagnosis of atrial fibrillation (AF) before stroke is a priority in successful stroke prevention. Despite guidelines that advocate pulse palpation for AF screening, it is not performed routinely in clinical practice. Various handheld or smartphone devices designed to specifically detect AF have gained much popularity. Of these state-of-the-art devices, the AliveCor Heart Monitor, a smartphone-based heart monitor that incorporates dry electrodes mounted on a smartphone case capable of recording a single-lead ECG, has already been US Food and Drug Administration-cleared and Conformité Européene-marked. In Europe, an automatic oscillometric blood pressure device that incorporates a specific algorithm to detect AF (Microlife WatchBP Office AFIB, Microlife AG) has been recommended by the UK National Institute for Health and Care Excellence to screen for AF during office blood pressure measurement in patients ≥65 years of age. These new devices have typically been evaluated in relatively small populations and not compared head to head. Their general use for widespread AF screening in a primary healthcare setting remains questionable. We report the findings of a prospective AF screening study coordinated by the University of Hong Kong and the Department of Family Medicine and Primary Healthcare Services, Hong Kong East Cluster, Hospital Authority1 to compare the diagnostic performance of these 2 devices in a primary healthcare setting. From September 2014 to January 2015, patients ≥65 years of age with hypertension or diabetes mellitus, who attended the Violet Peel General Outpatient Clinic in Hong Kong, were eligible for the study. Those patients with a pacemaker/implantable defibrillator were excluded. The study was approved by the Institutional Review Board (HKEC-2014–079), Hong Kong East Cluster, Hospital Authority, Hong Kong. After obtaining informed consent, AF screening was performed with the Microlife device, followed by the AliveCor detector. For AF detection by the AliveCor detector, the automated AFib detection algorithm (version 2.2.2) was utilized. When a diagnosis of AF was made by either device, a standard 12-lead ECG was performed. The primary analysis was to evaluate and compare the diagnostic performance of the devices to detect AF against a reference diagnosis based on 2 blinded and independent cardiologists' interpretation of a single-lead I ECG tracing recorded by the AliveCor device. It is important to note that no interobserver disagreement was discovered in the rhythm identification.A total of 2052 patients (mean age: 67.8±10.6 years; male: 45.8%) were recruited: hypertension was present in 83.2%, diabetes mellitus in 44.9%, coronary artery disease in 4.6%, and stroke in 4.6%. The mean CHA2DS2-VASc score was 2.8±1.3. AF was diagnosed in 24 patients (1.17%). The proportion of patients diagnosed with AF increased with age: <65 years: 0.1%, 65 to 74 years: 0.9%, ≥75 years 3.0% (P 98%). The diagnostic performance as determined by area under the curve was comparable for the AliveCor detector (0.83, 95% confidence interval: 0.81–0.85) and the Microlife device (0.91, 95% confidence interval: 0.90–0.92) (P=0.106)Download figureDownload PowerPointFigure 1. Diagnostic performance of AliveCor detector and Microlife device. A, Contingency table (left) of AliveCor automated atrial fibrillation (AF) detector for AF detection and rhythm diagnoses, and bar chart (right) showing its sensitivity and specificity. B, Contingency table (left) of Microlife WatchBP Office AFIB for AF detection and rhythm diagnoses, and bar chart (right) showing its sensitivity and specificity. PAC indicates premature atrial contractions; and PVC, premature ventricular contractions.Although an ideal screening test should have 100% sensitivity and 100% specificity, no test ever does. In our study, the sensitivity of both devices was lower than that in their validation studies.2–4 Particularly for the AliveCor detector, the sensitivity was 66.7% compared with the reported 98% and 98.5%.3,4 The penalty for low sensitivity (ie, missing a case of AF) is the dire consequence of stroke. For instance, one third of patients with AF would be missed by the AliveCor detector. Previous studies utilizing older AliveCor versions reported different sensitivities, possibly due to modifications in detector's detection algorithm. Alternatively, the slightly lower specificity of the Microlife device would translate into extra workload to perform a standard 12-lead ECG to exclude AF. It is important to note that multiple measurements by either of these tests at intervals undoubtedly improve the sensitivity for AF detection.5 In a situation where standard 12-lead ECG is not readily available, uncertainty in diagnosis may result in undue anxiety. Nonetheless, given the high rates of undetected AF in the primary healthcare setting and the effectiveness of new anticoagulants, the introduction of these devices into routine practice could have a substantial impact on reducing the stroke burden.Pak-Hei Chan, MBBSChun-Ka Wong, MBBSLouise Pun, BAYu-Fai Wong, MBBSMichelle Man-Ying Wong, MBBSDaniel Wai-Sing Chu, MBBSChung-Wah Siu, MDDisclosuresNone.FootnotesCirculation is available at http://circ.ahajournals.org.Correspondence to: Chung-Wah Siu, MD, Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China. E-mail [email protected]References1. Chan PH, Wong CK, Poh YC, Pun L, Leung WW, Wong YF, Wong MM, Poh MZ, Chu DW, Siu CW. Diagnostic performance of a smartphone-based photoplethysmographic application for atrial fibrillation screening in a primary care setting.Journal of the American Heart Association. 2016; 5: e003428. doi: 10.1161/JAHA.116.003428.LinkGoogle Scholar2. Kearley K, Selwood M, Van den Bruel A, Thompson M, Mant D, Hobbs FR, Fitzmaurice D, Heneghan C. Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors.BMJ Open. 2014; 4:e004565. doi: 10.1136/bmjopen-2013-004565.CrossrefMedlineGoogle Scholar3. Lowres N, Neubeck L, Salkeld G, Krass I, McLachlan A, Redfern J, Bennett A, Briffa T, Bauman A, Martinez C. Feasibility and cost effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies.The SEARCH-AF study. Thromb Haemost. 2014; 99:295–304.Google Scholar4. Lau JK, Lowres N, Neubeck L, Brieger DB, Sy RW, Galloway CD, Albert DE, Freedman SB. iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke.Int J Cardiol. 2013; 165:193–194. doi: 10.1016/j.ijcard.2013.01.220.CrossrefMedlineGoogle Scholar5. 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January 3, 2017Vol 135, Issue 1 Advertisement Article InformationMetrics © 2016 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.116.024439PMID: 28028066 Originally publishedJanuary 3, 2017 Keywordsatrial fibrillationsmartphonescreeningPDF download Advertisement SubjectsAtrial Fibrillation
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