{Reference Type}: Journal Article
{Title}: Performance of Single-Lead Handheld Electrocardiograms for Atrial Fibrillation Screening in Primary Care: The VITAL-AF Trial.
{Author}: Khurshid S;Chang Y;Borowsky LH;McManus DD;Ashburner JM;Atlas SJ;Ellinor PT;Singer DE;Lubitz SA;
{Journal}: JACC Adv
{Volume}: 2
{Issue}: 8
{Year}: 2023 Oct
暂无{DOI}: 10.1016/j.jacadv.2023.100616
{Abstract}: <B>UNASSIGNED: </B>Handheld single-lead electrocardiographic (1L ECG) devices are increasingly used for atrial fibrillation (AF) screening, but their real-world performance is not well understood.<BR><B>UNASSIGNED: </B>The purpose of this study was to quantify the diagnostic test characteristics of 1L ECG automated interpretations for prospective AF screening.<BR><B>UNASSIGNED: </B>We calculated the diagnostic test characteristics of the AliveCor KardiaMobile 1L ECG (AliveCor, US) algorithm using unblinded cardiologist overread as the gold standard using single 30s tracings administered by medical assistants among individuals aged ≥65 years participating in the VITAL-AF trial (NCT03515057) of population-based AF screening embedded within routine primary care.<BR><B>UNASSIGNED: </B>A total of 14,230 individuals (mean age 74 ± 7 years, 60% women, 82% White) had 31,376 tracings reviewed by 13 cardiologists. A total of 24,906 (79.6%) tracings had an AliveCor interpretation of normal, 5,046 (16.1%) were unclassified, 797 (2.5%) were possible AF, and 573 (1.8%) were no analysis. Cardiologists read 808 (2.6%) tracings as AF. AliveCor possible AF had a PPV of 51.7% (95% CI: 47.8%-55.6%). AliveCor normal had an NPV of 99.8% (95% CI: 99.7%-99.8%). The AliveCor algorithm had an overall sensitivity of 51.0% (95% CI: 47.1%-54.9%) and a specificity of 98.7% (95% CI: 98.6%-98.9%). AliveCor tracings interpreted as unclassified (PPV 5.9%, 95% CI: 5.1%-6.7%) and no analysis (PPV 6.5%, 95% CI: 4.6%-8.9%) had low predictive values for AF and were increasingly prevalent at older ages (13.7% for age 65-69 years to 28.1% for age ≥85 years, P < 0.01).<BR><B>UNASSIGNED: </B>In an older primary care population undergoing AF screening with handheld 1L ECGs, automated algorithm interpretations were sufficiently accurate to exclude the presence of AF but not to establish an AF diagnosis.