Arrhythmias & electrophysiology
Performance of Single-Lead Handheld Electrocardiograms for Atrial Fibrillation Screening in Primary Care: The VITAL-AF Trial
Authors' conclusion
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.
Study context
- Population
- Individuals aged ≥65 years in population-based atrial fibrillation (AF) screening within routine primary care (VITAL-AF trial)31,376 tracings
- Participants
- 14,230 individuals
- Comparison
- AliveCor KardiaMobile 1L ECG algorithm vs cardiologist overread
- Outcome
- Diagnostic test characteristics of 1L ECG automated interpretations for AF
Methodological detailsprospective, embedded in the VITAL-AF trial, unblinded cardiologist overread as gold standard, 31,376 tracings reviewed by 13 cardiologists; single 30s tracings administered by medical assistants
- Prospective
- Embedded in the VITAL-AF trial
- Unblinded cardiologist overread as gold standard
- 31,376 tracings reviewed by 13 cardiologists; single 30s tracings administered by medical assistants
Performance
As reported in the abstract
AF detection
| Test or model | Sensitivity | Specificity | PPV (possible AF) | NPV (normal) |
|---|---|---|---|---|
| AliveCor algorithm | 51.0% (95% CI: 47.1%-54.9%) | 98.7% (95% CI: 98.6%-98.9%) | 51.7% (95% CI: 47.8%-55.6%) | 99.8% (95% CI: 99.7%-99.8%) |
AliveCor algorithm
Sensitivity51.0% (95% CI: 47.1%-54.9%)
Specificity98.7% (95% CI: 98.6%-98.9%)
PPV (possible AF)51.7% (95% CI: 47.8%-55.6%)
NPV (normal)99.8% (95% CI: 99.7%-99.8%)
Further findings
AliveCor interpretation categories
- Normal
- 24,906 (79.6%)
- Unclassified
- 5,046 (16.1%)
- Possible AF
- 797 (2.5%)
- No analysis
- 573 (1.8%)
PPV for AF of unclassified and no-analysis tracings
- Unclassified PPV
- 5.9% (95% CI: 5.1%-6.7%)
- No analysis PPV
- 6.5% (95% CI: 4.6%-8.9%)
- Unclassified/no analysis prevalence by age, 65-69 vs ≥85 years
- 13.7% to 28.1%, P < 0.01
Original publication
Performance of Single-Lead Handheld Electrocardiograms for Atrial Fibrillation Screening in Primary Care: The VITAL-AF Trial. JACC Adv. Published 20 September 2023. doi:10.
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