@article {Kearleye004565, author = {Karen Kearley and Mary Selwood and Ann Van den Bruel and Matthew Thompson and David Mant and FD Richard Hobbs and David Fitzmaurice and Carl Heneghan}, title = {Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors}, volume = {4}, number = {5}, elocation-id = {e004565}, year = {2014}, doi = {10.1136/bmjopen-2013-004565}, publisher = {British Medical Journal Publishing Group}, abstract = {Objective New electronic devices offer an opportunity within routine primary care settings for improving the detection of atrial fibrillation (AF), which is a common cardiac arrhythmia and a modifiable risk factor for stroke. We aimed to assess the performance of a modified blood pressure (BP) monitor and two single-lead ECG devices, as diagnostic triage tests for the detection of AF. Setting 6 General Practices in the UK. Participants 1000 ambulatory patients aged 75 years and over. Primary and secondary outcome measures Comparative diagnostic accuracy of modified BP monitor and single-lead ECG devices, compared to reference standard of 12-lead ECG, independently interpreted by cardiologists. Results A total of 79 participants (7.9\%) had AF diagnosed by 12-lead ECG. All three devices had a high sensitivity (93.9{\textendash}98.7\%) and are useful for ruling out AF. WatchBP is a better triage test than Omron autoanalysis because it is more specific{\textemdash}89.7\% (95\% CI 87.5\% to 91.6\%) compared to 78.3\% (95\% CI 73.0\% to 82.9\%), respectively. This would translate into a lower follow-on ECG rate of 17\% to rule in/rule out AF compared to 29.7\% with the Omron text message in the study population. The overall specificity of single-lead ECGs analysed by a cardiologist was 94.6\% for Omron and 90.1\% for Merlin. Conclusions WatchBP performs better as a triage test for identifying AF in primary care than the single-lead ECG monitors as it does not require expertise for interpretation and its diagnostic performance is comparable to single-lead ECG analysis by cardiologists. It could be used opportunistically to screen elderly patients for undiagnosed AF at regular intervals and/or during BP measurement.}, issn = {2044-6055}, URL = {https://bmjopen.bmj.com/content/4/5/e004565}, eprint = {https://bmjopen.bmj.com/content/4/5/e004565.full.pdf}, journal = {BMJ Open} }