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,...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Sage
2015
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| Online Access: | https://eprints.nottingham.ac.uk/40704/ |
| _version_ | 1848796120501714944 |
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| author | Taggar, Jaspal S. Coleman, Tim Lewis, Sarah Heneghan, Carl Jones, Matthew |
| author_facet | Taggar, Jaspal S. Coleman, Tim Lewis, Sarah Heneghan, Carl Jones, Matthew |
| author_sort | Taggar, Jaspal S. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| 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. |
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| format | Article |
| id | nottingham-40704 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T19:42:56Z |
| publishDate | 2015 |
| publisher | Sage |
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| spelling | nottingham-407042020-05-08T12:15:15Z https://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 https://eprints.nottingham.ac.uk/40704/1/Taggar%20Eur%20J%20Prev%20Cardiol.pdf Taggar, Jaspal S., Coleman, Tim, Lewis, Sarah, 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 Atrial fibrillation screening diagnostic accuracy irregular pulse http://journals.sagepub.com/doi/10.1177/2047487315611347 doi:10.1177/2047487315611347 doi:10.1177/2047487315611347 |
| spellingShingle | Atrial fibrillation screening diagnostic accuracy irregular pulse 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 |
| title | 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_short | 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 |
| topic | Atrial fibrillation screening diagnostic accuracy irregular pulse |
| url | https://eprints.nottingham.ac.uk/40704/ https://eprints.nottingham.ac.uk/40704/ https://eprints.nottingham.ac.uk/40704/ |