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

Abstract

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.

Citation

Taggar, J. S., Coleman, T., Lewis, S., Heneghan, C., & Jones, M. (2016). 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), 1330-1338. https://doi.org/10.1177/2047487315611347

• Journal Article Type: Article
• Acceptance Date: Sep 22, 2015
• Online Publication Date: Oct 13, 2015
• Publication Date: Aug 30, 2016
• Deposit Date: Feb 22, 2017
• Publicly Available Date: Feb 22, 2017
• Journal: European Journal of Preventive Cardiology
• Print ISSN: 2047-4873
• Electronic ISSN: 2047-4881
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 23
• Issue: 12
• Pages: 1330-1338
• DOI: https://doi.org/10.1177/2047487315611347
• Keywords: Atrial fibrillation, screening, diagnostic accuracy, irregular pulse
• Public URL: https://nottingham-repository.worktribe.com/output/763974
• Publisher URL: http://journals.sagepub.com/doi/10.1177/2047487315611347
• Contract Date: Feb 22, 2017