Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous Telemetry
Rogalewski A, Plümer J, Feldmann T, Oelschläger C, Greeve I, Kitsiou A, Schellinger PD, Israel CW, Schäbitz W-R (2020)
Cerebrovascular Diseases 49(6): 647-655.
Zeitschriftenaufsatz
| Veröffentlicht | Englisch
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Autor*in
Rogalewski, AndreasUniBi ;
Plümer, JorgeUniBi;
Feldmann, Tobias;
Oelschläger, Christian;
Greeve, IsabellUniBi;
Kitsiou, AlkistiUniBi;
Schellinger, Peter D.;
Israel, Carsten Walter;
Schäbitz, Wolf-RüdigerUniBi
Einrichtung
Abstract / Bemerkung
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.
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.
Erscheinungsjahr
2020
Zeitschriftentitel
Cerebrovascular Diseases
Band
49
Ausgabe
6
Seite(n)
647-655
ISSN
1015-9770
eISSN
1421-9786
Page URI
https://pub.uni-bielefeld.de/record/2964852
Zitieren
Rogalewski A, Plümer J, Feldmann T, et al. Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous Telemetry. Cerebrovascular Diseases. 2020;49(6):647-655.
Rogalewski, A., Plümer, J., Feldmann, T., Oelschläger, C., Greeve, I., Kitsiou, A., Schellinger, P. D., et al. (2020). Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous Telemetry. Cerebrovascular Diseases, 49(6), 647-655. https://doi.org/10.1159/000511563
Rogalewski, Andreas, Plümer, Jorge, Feldmann, Tobias, Oelschläger, Christian, Greeve, Isabell, Kitsiou, Alkisti, Schellinger, Peter D., Israel, Carsten Walter, and Schäbitz, Wolf-Rüdiger. 2020. “Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous Telemetry”. Cerebrovascular Diseases 49 (6): 647-655.
Rogalewski, A., Plümer, J., Feldmann, T., Oelschläger, C., Greeve, I., Kitsiou, A., Schellinger, P. D., Israel, C. W., and Schäbitz, W. - R. (2020). Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous Telemetry. Cerebrovascular Diseases 49, 647-655.
Rogalewski, A., et al., 2020. Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous Telemetry. Cerebrovascular Diseases, 49(6), p 647-655.
A. Rogalewski, et al., “Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous Telemetry”, Cerebrovascular Diseases, vol. 49, 2020, pp. 647-655.
Rogalewski, A., Plümer, J., Feldmann, T., Oelschläger, C., Greeve, I., Kitsiou, A., Schellinger, P.D., Israel, C.W., Schäbitz, W.-R.: Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous Telemetry. Cerebrovascular Diseases. 49, 647-655 (2020).
Rogalewski, Andreas, Plümer, Jorge, Feldmann, Tobias, Oelschläger, Christian, Greeve, Isabell, Kitsiou, Alkisti, Schellinger, Peter D., Israel, Carsten Walter, and Schäbitz, Wolf-Rüdiger. “Detection of Atrial Fibrillation on Stroke Units: Comparison of Manual versus Automatic Analysis of Continuous Telemetry”. Cerebrovascular Diseases 49.6 (2020): 647-655.
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