title: Screening for atrial fibrillation with automated blood pressure measurement: Research evidence and practice recommendations.
abstract: Several guidelines recommend opportunistic screening for atrial fibrillation (AF) in subjects aged ≥ 65 years using pulse palpation during routine blood pressure (BP) measurement. However, this method has limited diagnostic accuracy. A specific algorithm for AF detection during automated BP measurement was developed and implemented in a novel oscillometric device (Microlife WatchBP Home-A). In 2013, the UK National Institute for Health and Care Excellence (NICE) recommended this device for AF screening during routine office BP measurement in primary care in subjects ≥ 65 years. A review and meta-analysis of the evidence on the diagnostic accuracy of this algorithm were performed. Six studies (n=2332) investigated the accuracy of AF detection using the Microlife BP monitor and estimated a pooled sensitivity at 0.98 (95% CI 0.95, 1.00) and specificity 0.92 (0.88, 0.96). Analysis of 4 studies (n=1126) showed more readings to improve specificity (from 0.86 to 0.91) and sensitivity (from 0.97 to 0.99). Taking 3 sequential readings with at least 2 detecting AF gave the highest diagnostic accuracy. A single study (n=139) of paroxysmal AF screening with home BP monitoring (3316 days) showed sensitivity 99% and specificity 93%. Another study (n=46) of AF screening with 24h ambulatory BP monitoring showed that AF detected in >15% of all readings has high probability of AF diagnosis requiring confirmation by 24h electrocardiography. AF detection with routine automated BP measurement is a reliable screening tool in the elderly, which requires confirmation by electrocardiography. Paroxysmal AF might also be detected by routine automated home or ambulatory BP monitoring.
authors.affiliation: Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands; Microlife AG, Widnau, Switzerland. Electronic address: Willem.verberk@microlife.ch.
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Verberk
authors.affiliation: Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Omboni
authors.affiliation: Hypertension Center STRIDE-7, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Kollias
authors.affiliation: Hypertension Center STRIDE-7, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
authors.forename: George S
authors.initials: GS
authors.lastname: Stergiou
mesh_terms: D000375:Aging; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods*; D015924:Blood Pressure Monitors; D042241:Early Diagnosis; D055317:Evidence-Based Practice; D017408:Guidelines as Topic; D006339:Heart Rate; D006801:Humans; D015201:Meta-Analysis as Topic; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
keywords: Arrhythmia; Blood pressure monitoring; Clinic; Home blood pressure; Self-measurement; Stroke