Cerebrovascular Diseases
Clinical Research in Stroke
Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous TelemetryRogalewski A.a · Plümer J.a · Feldmann T.b · Oelschläger C.a · Greeve I.a · Kitsiou A.a · Schellinger P.D.c · Israel C.W.b · Schäbitz W.-R.aaDepartment of Neurology, Evangelisches Klinikum Bethel, EvKB, Bielefeld, Bielefeld, Germany
bDepartment of Cardiology, Evangelisches Klinikum Bethel, EvKB, Bielefeld, Bielefeld, Germany cDepartment of Neurology and Neurogeriatrics, Ruhr-University Bochum, Johannes-Wesling-Klinikum Minden, UK RUB, Minden, Germany |
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Article / Publication Details
Received: July 22, 2020
Accepted: September 12, 2020
Published online: November 18, 2020
Issue release date: December 2020
Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 2
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
Abstract
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.
© 2020 S. Karger AG, Basel
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Article / Publication Details
Received: July 22, 2020
Accepted: September 12, 2020
Published online: November 18, 2020
Issue release date: December 2020
Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 2
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
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