title: Performance of handheld electrocardiogram devices to detect atrial fibrillation in a cardiology and geriatric ward setting.
abstract: OBJECTIVE
  To determine the usability, accuracy, and cost-effectiveness of two handheld single-lead electrocardiogram (ECG) devices for atrial fibrillation (AF) screening in a hospital population with an increased risk for AF.
  
  
  RESULTS
  Hospitalized patients (n = 445) at cardiological or geriatric wards were screened for AF by two handheld ECG devices (MyDiagnostick and AliveCor). The performance of the automated algorithm of each device was evaluated against a full 12-lead or 6-lead ECG recording. All ECGs and monitor tracings were also independently reviewed in a blinded fashion by two electrophysiologists. Time investments by nurses and physicians were tracked and used to estimate cost-effectiveness of different screening strategies. Handheld recordings were not possible in 7 and 21.4% of cardiology and geriatric patients, respectively, because they were not able to hold the devices properly. Even after the exclusion of patients with an implanted device, sensitivity and specificity of the automated algorithms were suboptimal (Cardiology: 81.8 and 94.2%, respectively, for MyDiagnostick; 54.5 and 97.5%, respectively, for AliveCor; Geriatrics: 89.5 and 95.7%, respectively, for MyDiagnostick; 78.9 and 97.9%, respectively, for AliveCor). A scenario based on automated AliveCor evaluation in patients without AF history and without an implanted device proved to be the most cost-effective method, with a provider cost to identify one new AF patient of €193 and €82 at cardiology and geriatrics, respectively. The cost to detect one preventable stroke per year would be €7535 and €1916, respectively (based on average CHA2DS2-VASc of 3.9 ± 2.0 and 5.0 ± 1.5, respectively). Manual interpretation increases sensitivity, but decreases specificity, doubling the cost per detected patient, but remains cheaper than sole 12-lead ECG screening.
  
  
  CONCLUSIONS
  Using AliveCor or MyDiagnostick handheld recorders requires a structured screening strategy to be effective and cost-effective in a hospital setting. It must exclude patients with implanted devices and known AF, and requires targeted additional 12-lead ECGs to optimize specificity. Under these circumstances, the expenses per diagnosed new AF patient and preventable stroke are reasonable.
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium liendesteghe@gmail.com lien.desteghe@uhasselt.be.|Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
authors.forename: Lien
authors.initials: L
authors.lastname: Desteghe
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.
authors.forename: Zina
authors.initials: Z
authors.lastname: Raymaekers
authors.affiliation: Department of geriatrics, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: Lutin
authors.affiliation: Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Vijgen
authors.affiliation: Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Dilling-Boer
authors.affiliation: Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Koopman
authors.affiliation: Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Schurmans
authors.affiliation: Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanduynhoven
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.|Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Dendale
authors.affiliation: Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.|Heart Center Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
mesh_terms: D000200:Action Potentials; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology; D001530:Belgium; D016507:Cardiology Service, Hospital / Q000191:economics; D040421:Cell Phone / Q000191:economics; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004562:Electrocardiography / Q000191:economics / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005853:Geriatrics / Q000191:economics; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D018803:Models, Economic; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D062606:Tertiary Care Centers
keywords: Atrial fibrillation; Cost-effectiveness; Electrocardiogram; Handheld ECG; Screening