Skip to main content

Research Repository

Advanced Search

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

Authors

Dr JASPAL TAGGAR Jaspal.Taggar@nottingham.ac.uk
Clinical Associate Professor and Headof Primary Care Undergraduate Education

TIM COLEMAN tim.coleman@nottingham.ac.uk
Professor of Primary Care

Carl Heneghan

Dr MATTHEW JONES MATTHEW.JONES3@NOTTINGHAM.AC.UK
Assistant Professor in Health Economics



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.

Journal Article Type Article
Publication Date Aug 30, 2016
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
APA6 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
DOI https://doi.org/10.1177/2047487315611347
Keywords Atrial fibrillation, screening, diagnostic accuracy, irregular pulse
Publisher URL http://journals.sagepub.com/doi/10.1177/2047487315611347
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/4.0

Files

Taggar Eur J Prev Cardiol.pdf (659 Kb)
PDF

Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/4.0





You might also like



Downloadable Citations

;