Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis

Background: Pulse palpation has been recommended as the first step of screening to detect atrial fibrillation. We aimed to determine and compare the accuracy of different methods for detecting pulse irregularities caused by atrial fibrillation. Methods: We systematically searched MEDLINE, EMBASE,...

Full description

Bibliographic Details
Main Authors:	Taggar, Jaspal S., Coleman, Tim, Lewis, Sarah, Heneghan, Carl, Jones, Matthew
Format:	Article
Language:	English
Published:	Sage 2015
Online Access:	http://eprints.nottingham.ac.uk/40704/ http://eprints.nottingham.ac.uk/40704/ http://eprints.nottingham.ac.uk/40704/ http://eprints.nottingham.ac.uk/40704/1/Taggar%20Eur%20J%20Prev%20Cardiol.pdf

id	nottingham-40704
recordtype	eprints
spelling	nottingham-407042018-06-26T12:38:46Z http://eprints.nottingham.ac.uk/40704/ Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis Taggar, Jaspal S. Coleman, Tim Lewis, Sarah Heneghan, Carl Jones, Matthew Background: Pulse palpation has been recommended as the first step of screening to detect atrial fibrillation. We aimed to determine and compare the accuracy of different methods for detecting pulse irregularities caused by atrial fibrillation. Methods: We systematically searched MEDLINE, EMBASE, CINAHL and LILACS until 16 March 2015. Two reviewers identified eligible studies, extracted data and appraised quality using the QUADAS-2 instrument. Meta-analysis, using the bivariate hierarchical random effects method, determined average operating points for sensitivities, specificities, positive and negative likelihood ratios (PLR, NLR); we constructed summary receiver operating characteristic plots. Results: Twenty-one studies investigated 39 interventions (n = 15,129 pulse assessments) for detecting atrial fibrillation. Compared to 12-lead electrocardiography (ECG) diagnosed atrial fibrillation, blood pressure monitors (BPMs; seven interventions) and non-12-lead ECGs (20 interventions) had the greatest accuracy for detecting pulse irregularities attributable to atrial fibrillation (BPM: sensitivity 0.98 (95% confidence interval (CI) 0.92–1.00), specificity 0.92 (95% CI 0.88–0.95), PLR 12.1 (95% CI 8.2–17.8) and NLR 0.02 (95% CI 0.00–0.09); non-12-lead ECG: sensitivity 0.91 (95% CI 0.86–0.94), specificity 0.95 (95% CI 0.92–0.97), PLR 20.1 (95% CI 12–33.7), NLR 0.09 (95% CI 0.06–0.14)). There were similar findings for smartphone applications (six interventions) although these studies were small in size. The sensitivity and specificity of pulse palpation (six interventions) were 0.92 (95% CI 0.85–0.96) and 0.82 (95% CI 0.76–0.88), respectively (PLR 5.2 (95% CI 3.8–7.2), NLR 0.1 (95% CI 0.05–0.18)). Conclusions: BPMs and non-12-lead ECG were most accurate for detecting pulse irregularities caused by atrial fibrillation; other technologies may therefore be pragmatic alternatives to pulse palpation for the first step of atrial fibrillation screening. Sage 2015-10-13 Article PeerReviewed application/pdf en cc_by_nc http://eprints.nottingham.ac.uk/40704/1/Taggar%20Eur%20J%20Prev%20Cardiol.pdf Taggar, Jaspal S. and Coleman, Tim and Lewis, Sarah and Heneghan, Carl and Jones, Matthew (2015) Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis. European Journal of Preventive Cardiology, 23 (12). pp. 1330-1338. ISSN 2047-4881 http://journals.sagepub.com/doi/10.1177/2047487315611347 doi:10.1177/2047487315611347 doi:10.1177/2047487315611347
repository_type	Digital Repository
institution_category	Local University
institution	University of Nottingham Malaysia Campus
building	Nottingham Research Data Repository
collection	Online Access
language	English
description	Background: Pulse palpation has been recommended as the first step of screening to detect atrial fibrillation. We aimed to determine and compare the accuracy of different methods for detecting pulse irregularities caused by atrial fibrillation. Methods: We systematically searched MEDLINE, EMBASE, CINAHL and LILACS until 16 March 2015. Two reviewers identified eligible studies, extracted data and appraised quality using the QUADAS-2 instrument. Meta-analysis, using the bivariate hierarchical random effects method, determined average operating points for sensitivities, specificities, positive and negative likelihood ratios (PLR, NLR); we constructed summary receiver operating characteristic plots. Results: Twenty-one studies investigated 39 interventions (n = 15,129 pulse assessments) for detecting atrial fibrillation. Compared to 12-lead electrocardiography (ECG) diagnosed atrial fibrillation, blood pressure monitors (BPMs; seven interventions) and non-12-lead ECGs (20 interventions) had the greatest accuracy for detecting pulse irregularities attributable to atrial fibrillation (BPM: sensitivity 0.98 (95% confidence interval (CI) 0.92–1.00), specificity 0.92 (95% CI 0.88–0.95), PLR 12.1 (95% CI 8.2–17.8) and NLR 0.02 (95% CI 0.00–0.09); non-12-lead ECG: sensitivity 0.91 (95% CI 0.86–0.94), specificity 0.95 (95% CI 0.92–0.97), PLR 20.1 (95% CI 12–33.7), NLR 0.09 (95% CI 0.06–0.14)). There were similar findings for smartphone applications (six interventions) although these studies were small in size. The sensitivity and specificity of pulse palpation (six interventions) were 0.92 (95% CI 0.85–0.96) and 0.82 (95% CI 0.76–0.88), respectively (PLR 5.2 (95% CI 3.8–7.2), NLR 0.1 (95% CI 0.05–0.18)). Conclusions: BPMs and non-12-lead ECG were most accurate for detecting pulse irregularities caused by atrial fibrillation; other technologies may therefore be pragmatic alternatives to pulse palpation for the first step of atrial fibrillation screening.
format	Article
author	Taggar, Jaspal S. Coleman, Tim Lewis, Sarah Heneghan, Carl Jones, Matthew
spellingShingle	Taggar, Jaspal S. Coleman, Tim Lewis, Sarah Heneghan, Carl Jones, Matthew Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis
author_facet	Taggar, Jaspal S. Coleman, Tim Lewis, Sarah Heneghan, Carl Jones, Matthew
author_sort	Taggar, Jaspal S.
title	Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis
title_short	Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis
title_full	Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis
title_fullStr	Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis
title_full_unstemmed	Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis
title_sort	accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis
publisher	Sage
publishDate	2015
url	http://eprints.nottingham.ac.uk/40704/ http://eprints.nottingham.ac.uk/40704/ http://eprints.nottingham.ac.uk/40704/ http://eprints.nottingham.ac.uk/40704/1/Taggar%20Eur%20J%20Prev%20Cardiol.pdf
first_indexed	2018-09-06T13:08:16Z
last_indexed	2018-09-06T13:08:16Z
_version_	1610863657070100480

Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: a systematic review and meta-analysis

Similar Items