Detection of Atrial Fibrillation on Stroke Units : Comparison of Manual versus Automatic Analysis of Continuous Telemetry
© 2020 S. Karger AG, Basel..
BACKGROUND: Detection of atrial fibrillation (AF) is one of the primary diagnostic goals for patients on a stroke unit. Physician-based manual analysis of continuous ECG monitoring is regarded as the gold standard for AF detection but requires considerable resources. Recently, automated computer-based analysis of RR intervals was established to simplify AF detection. The present prospective study analyzes both methods head to head regarding AF detection specificity, sensitivity, and overall effectiveness.
METHODS: Consecutive stroke patients without history of AF or proof of AF in the admission ECG were enrolled over the period of 7 months. All patients received continuous ECG telemetry during the complete stay on the stroke unit. All ECGs underwent automated analysis by a commercially available program. Blinded to these results, all ECG tracings were also assessed manually. Sensitivity, specificity, time consumption, costs per day, and cost-effectiveness were compared.
RESULTS: 216 consecutive patients were enrolled (70.7 ± 14.1 years, 56% male) and 555 analysis days compared. AF was detected by manual ECG analysis on 37 days (6.7%) and automatically on 57 days (10.3%). Specificity of the automated algorithm was 94.6% and sensitivity 78.4% (28 [5.0%] false positive and 8 [1.4%] false negative). Patients with AF were older and had more often arterial hypertension, higher NIHSS at admission, more often left atrial dilatation, and a higher CHA2DS2-VASc score. Automation significantly reduced human resources but was more expensive compared to manual analysis alone.
CONCLUSION: Automatic AF detection is highly specific, but sensitivity is relatively low. Results of this study suggest that automated computer-based AF detection should be rather complementary to manual ECG analysis than replacing it.
| Errataetall: |
CommentIn: Cerebrovasc Dis. 2020;49(6):656-658. - PMID 33227784 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:49 |
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| Enthalten in: |
Cerebrovascular diseases (Basel, Switzerland) - 49(2020), 6 vom: 11., Seite 647-655 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rogalewski, Andreas [VerfasserIn] |
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| Links: |
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| Themen: |
Atrial fibrillation |
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| Anmerkungen: |
Date Completed 29.03.2021 Date Revised 29.03.2021 published: Print-Electronic CommentIn: Cerebrovasc Dis. 2020;49(6):656-658. - PMID 33227784 Citation Status MEDLINE |
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| doi: |
10.1159/000511563 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM317745182 |
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| 100 | 1 | |a Rogalewski, Andreas |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Detection of Atrial Fibrillation on Stroke Units |b Comparison of Manual versus Automatic Analysis of Continuous Telemetry |
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| 500 | |a CommentIn: Cerebrovasc Dis. 2020;49(6):656-658. - PMID 33227784 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 S. Karger AG, Basel. | ||
| 520 | |a BACKGROUND: Detection of atrial fibrillation (AF) is one of the primary diagnostic goals for patients on a stroke unit. Physician-based manual analysis of continuous ECG monitoring is regarded as the gold standard for AF detection but requires considerable resources. Recently, automated computer-based analysis of RR intervals was established to simplify AF detection. The present prospective study analyzes both methods head to head regarding AF detection specificity, sensitivity, and overall effectiveness | ||
| 520 | |a METHODS: Consecutive stroke patients without history of AF or proof of AF in the admission ECG were enrolled over the period of 7 months. All patients received continuous ECG telemetry during the complete stay on the stroke unit. All ECGs underwent automated analysis by a commercially available program. Blinded to these results, all ECG tracings were also assessed manually. Sensitivity, specificity, time consumption, costs per day, and cost-effectiveness were compared | ||
| 520 | |a RESULTS: 216 consecutive patients were enrolled (70.7 ± 14.1 years, 56% male) and 555 analysis days compared. AF was detected by manual ECG analysis on 37 days (6.7%) and automatically on 57 days (10.3%). Specificity of the automated algorithm was 94.6% and sensitivity 78.4% (28 [5.0%] false positive and 8 [1.4%] false negative). Patients with AF were older and had more often arterial hypertension, higher NIHSS at admission, more often left atrial dilatation, and a higher CHA2DS2-VASc score. Automation significantly reduced human resources but was more expensive compared to manual analysis alone | ||
| 520 | |a CONCLUSION: Automatic AF detection is highly specific, but sensitivity is relatively low. Results of this study suggest that automated computer-based AF detection should be rather complementary to manual ECG analysis than replacing it | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Atrial fibrillation | |
| 650 | 4 | |a Automated detection | |
| 650 | 4 | |a Manual detection | |
| 650 | 4 | |a SRAclinic | |
| 650 | 4 | |a Stroke | |
| 700 | 1 | |a Plümer, Jorge |e verfasserin |4 aut | |
| 700 | 1 | |a Feldmann, Tobias |e verfasserin |4 aut | |
| 700 | 1 | |a Oelschläger, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Greeve, Isabell |e verfasserin |4 aut | |
| 700 | 1 | |a Kitsiou, Alkisti |e verfasserin |4 aut | |
| 700 | 1 | |a Schellinger, Peter D |e verfasserin |4 aut | |
| 700 | 1 | |a Israel, Carsten Walter |e verfasserin |4 aut | |
| 700 | 1 | |a Schäbitz, Wolf-Rüdiger |e verfasserin |4 aut | |
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