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Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms (†)

Atrial fibrillation (AF) is a common irregular heart rhythm associated with a five-fold increase in stroke risk. It is often not recognised as it can occur intermittently and without symptoms. A promising approach to detect AF is to use a handheld electrocardiogram (ECG) sensor for screening. Howeve...

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Autores principales: Pandiaraja, Madhumitha, Brimicombe, James, Cowie, Martin, Dymond, Andrew, Lindén, Hannah Clair, Lip, Gregory Y. H., Mant, Jonathan, Williams, Kate, Charlton, Peter H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610434/
https://www.ncbi.nlm.nih.gov/pubmed/33778802
http://dx.doi.org/10.3390/ecsa-7-08195
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author Pandiaraja, Madhumitha
Brimicombe, James
Cowie, Martin
Dymond, Andrew
Lindén, Hannah Clair
Lip, Gregory Y. H.
Mant, Jonathan
Williams, Kate
Charlton, Peter H.
author_facet Pandiaraja, Madhumitha
Brimicombe, James
Cowie, Martin
Dymond, Andrew
Lindén, Hannah Clair
Lip, Gregory Y. H.
Mant, Jonathan
Williams, Kate
Charlton, Peter H.
author_sort Pandiaraja, Madhumitha
collection PubMed
description Atrial fibrillation (AF) is a common irregular heart rhythm associated with a five-fold increase in stroke risk. It is often not recognised as it can occur intermittently and without symptoms. A promising approach to detect AF is to use a handheld electrocardiogram (ECG) sensor for screening. However, the ECG recordings must be manually reviewed, which is time-consuming and costly. Our aims were to: (i) evaluate the manual review workload; and (ii) evaluate strategies to reduce the workload. In total, 2141 older adults were asked to record their ECG four times per day for 1–4 weeks in the SAFER (Screening for Atrial Fibrillation with ECG to Reduce stroke) Feasibility Study, producing 162,515 recordings. Patients with AF were identified by: (i) an algorithm classifying recordings based on signal quality (high or low) and heart rhythm; (ii) a nurse reviewing recordings to correct algorithm misclassifications; and (iii) two cardiologists independently reviewing recordings from patients with any evidence of rhythm abnormality. It was estimated that 30,165 reviews were required (20,155 by the nurse, and 5005 by each cardiologist). The total number of reviews could be reduced to 24,561 if low-quality recordings were excluded from review; 18,573 by only reviewing ECGs falling under certain pathological classifications; and 18,144 by only reviewing ECGs displaying an irregularly irregular rhythm for the entire recording. The number of AF patients identified would not fall considerably: from 54 to 54, 54 and 53, respectively. In conclusion, simple approaches may help feasibly reduce the manual workload by 38.4% whilst still identifying the same number of patients with undiagnosed, clinically relevant AF.
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spelling pubmed-76104342021-03-25 Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms (†) Pandiaraja, Madhumitha Brimicombe, James Cowie, Martin Dymond, Andrew Lindén, Hannah Clair Lip, Gregory Y. H. Mant, Jonathan Williams, Kate Charlton, Peter H. Eng Proc Article Atrial fibrillation (AF) is a common irregular heart rhythm associated with a five-fold increase in stroke risk. It is often not recognised as it can occur intermittently and without symptoms. A promising approach to detect AF is to use a handheld electrocardiogram (ECG) sensor for screening. However, the ECG recordings must be manually reviewed, which is time-consuming and costly. Our aims were to: (i) evaluate the manual review workload; and (ii) evaluate strategies to reduce the workload. In total, 2141 older adults were asked to record their ECG four times per day for 1–4 weeks in the SAFER (Screening for Atrial Fibrillation with ECG to Reduce stroke) Feasibility Study, producing 162,515 recordings. Patients with AF were identified by: (i) an algorithm classifying recordings based on signal quality (high or low) and heart rhythm; (ii) a nurse reviewing recordings to correct algorithm misclassifications; and (iii) two cardiologists independently reviewing recordings from patients with any evidence of rhythm abnormality. It was estimated that 30,165 reviews were required (20,155 by the nurse, and 5005 by each cardiologist). The total number of reviews could be reduced to 24,561 if low-quality recordings were excluded from review; 18,573 by only reviewing ECGs falling under certain pathological classifications; and 18,144 by only reviewing ECGs displaying an irregularly irregular rhythm for the entire recording. The number of AF patients identified would not fall considerably: from 54 to 54, 54 and 53, respectively. In conclusion, simple approaches may help feasibly reduce the manual workload by 38.4% whilst still identifying the same number of patients with undiagnosed, clinically relevant AF. 2020-11-14 /pmc/articles/PMC7610434/ /pubmed/33778802 http://dx.doi.org/10.3390/ecsa-7-08195 Text en https://creativecommons.org/licenses/by/4.0/This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pandiaraja, Madhumitha
Brimicombe, James
Cowie, Martin
Dymond, Andrew
Lindén, Hannah Clair
Lip, Gregory Y. H.
Mant, Jonathan
Williams, Kate
Charlton, Peter H.
Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms (†)
title Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms (†)
title_full Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms (†)
title_fullStr Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms (†)
title_full_unstemmed Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms (†)
title_short Screening for Atrial Fibrillation: Improving Efficiency of Manual Review of Handheld Electrocardiograms (†)
title_sort screening for atrial fibrillation: improving efficiency of manual review of handheld electrocardiograms (†)
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610434/
https://www.ncbi.nlm.nih.gov/pubmed/33778802
http://dx.doi.org/10.3390/ecsa-7-08195
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