Evidence map›Paper›PMID 24793250›Full record

ArticleBMJ open2014

Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors.

Karen Kearley, Mary Selwood, Ann Van den Bruel, Matthew Thompson, David Mant, Fd Richard Hobbs, David Fitzmaurice, Carl Heneghan

Open access · goldAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 4 pooled it
6.1field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 4 syntheses or guidelines pooled it, 106 citations in OpenAlex.

  1. Pooled it
  2. Guideline
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  5. Trial
  6. Interrater agreement in atrial fibrillation diagnosis using one-week single-lead patch ECG monitoring: findings from the NORSCREEN trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
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  9. Reliability of single-lead electrocardiogram interpretation to detect atrial fibrillation: insights from the SAFER feasibility study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
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  19. Mobile Health for Arrhythmia Diagnosis and Management.Journal of general internal medicine · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

Karen KearleyNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Mary Selwood
Ann Van den Bruel
Matthew Thompson
David Mant
Fd Richard Hobbs
David Fitzmaurice
Carl Heneghan
University of Oxford · GBUniversity of Birmingham · GBUniversity of Washington · US

Funding

Medical Research Council G9900264
6 · The paper itself

Abstract

objectiveNew 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.

setting6 General Practices in the UK.

participants1000 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.

resultsA total of 79 participants (7.9%) had AF diagnosed by 12-lead ECG. All three devices had a high sensitivity (93.9-98.7%) and are useful for ruling out AF. WatchBP is a better triage test than Omron autoanalysis because it is more specific-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.

conclusionsWatchBP 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.

Indexed as

Blood Pressure DeterminationElectrocardiographyPrimary Health CareTriageAgedAged, 80 and overAtrial FibrillationFemaleHumansMaleReproducibility of ResultsPrimary CareStroke Medicine

Identifiers

PMID24793250
PMCPMC4025411
OpenAlexW2161884253

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.