Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers

Aim We examined the diagnostic accuracy of single-lead ECG as assessed by radiographers and 12-lead ECG as assessed by cardiac nurses for the diagnosis of atrial fibrillation (AF).Methods Based on the Danish Cardiovascular Screening Trial, we conducted a population-based, cross-sectional study of 13...

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Main Authors: Jes Sanddal Lindholt, Axel Cosmus Pyndt Diederichsen, Lærke Marius Kvist, Nicklas Vinter, Grazina Urbonaviciene, Lars Frost
Format: Article
Language:English
Published: BMJ Publishing Group 2019-05-01
Series:Open Heart
Online Access:https://openheart.bmj.com/content/6/1/e000942.full
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author Jes Sanddal Lindholt
Axel Cosmus Pyndt Diederichsen
Lærke Marius Kvist
Nicklas Vinter
Grazina Urbonaviciene
Lars Frost
author_facet Jes Sanddal Lindholt
Axel Cosmus Pyndt Diederichsen
Lærke Marius Kvist
Nicklas Vinter
Grazina Urbonaviciene
Lars Frost
author_sort Jes Sanddal Lindholt
collection DOAJ
description Aim We examined the diagnostic accuracy of single-lead ECG as assessed by radiographers and 12-lead ECG as assessed by cardiac nurses for the diagnosis of atrial fibrillation (AF).Methods Based on the Danish Cardiovascular Screening Trial, we conducted a population-based, cross-sectional study of 1338 randomly selected Danish men aged 65–74 years with no exclusion criteria. The participants were screened with single-lead ECG during a CT scan assessed by radiographers and 12-lead ECG assessed by cardiac nurses. The diagnostic accuracy was evaluated compared with that produced by a 12-lead ECG assessed by two consenting cardiologists.Results The study identified 68 participants with ongoing AF, of whom 60 had self-reported AF and 8 had AF detected in the screening. Single-lead ECG assessed for AF by radiographers had a sensitivity of 60.3% (95% CI 47.7 to 72.0), specificity of 97.2% (95% CI 96.2 to 98.1), positive predictive value (PPV) of 53.9% (95% CI 42.1 to 65.5) and negative predictive value (NPV) of 97.9% (95% CI 96.9 to 98.6). 12-lead ECG assessed by cardiac nurses had a sensitivity of 97.1% (95% CI 89.8 to 99.6), specificity of 100% (95% CI 99.7 to 100), PPV of 100% (95% CI 94.6 to 100) and NPV of 99.8% (95% CI 99.4 to 100).Conclusions Single-lead ECG assessed by radiographers had a moderate sensitivity and PPV but a very high specificity and NPV. Using radiographers may be acceptable for opportunistic screening, in particular if radiographers are thoroughly trained. Thus, 12-lead ECG assessed by cardiac nurses is a potential diagnostic method for the detection of AF.
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spelling doaj-art-e6d6b13696074d648d85d0e86f6fbb302024-11-12T09:05:09ZengBMJ Publishing GroupOpen Heart2053-36242019-05-016110.1136/openhrt-2018-000942Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographersJes Sanddal Lindholt0Axel Cosmus Pyndt Diederichsen1Lærke Marius Kvist2Nicklas Vinter3Grazina Urbonaviciene4Lars Frost53 Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Odense Universitetshospital, Odense, Denmark4 Department of Cardiology, Odense University Hospital, Odense, Denmark1 Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark2 Department of Clinical Medicine, Aarhus Universitet, Aarhus, DenmarkDepartment of Cardiology, Regional Hospital of Central Jutland, Silkeborg, DenmarkUniversity Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, DenmarkAim We examined the diagnostic accuracy of single-lead ECG as assessed by radiographers and 12-lead ECG as assessed by cardiac nurses for the diagnosis of atrial fibrillation (AF).Methods Based on the Danish Cardiovascular Screening Trial, we conducted a population-based, cross-sectional study of 1338 randomly selected Danish men aged 65–74 years with no exclusion criteria. The participants were screened with single-lead ECG during a CT scan assessed by radiographers and 12-lead ECG assessed by cardiac nurses. The diagnostic accuracy was evaluated compared with that produced by a 12-lead ECG assessed by two consenting cardiologists.Results The study identified 68 participants with ongoing AF, of whom 60 had self-reported AF and 8 had AF detected in the screening. Single-lead ECG assessed for AF by radiographers had a sensitivity of 60.3% (95% CI 47.7 to 72.0), specificity of 97.2% (95% CI 96.2 to 98.1), positive predictive value (PPV) of 53.9% (95% CI 42.1 to 65.5) and negative predictive value (NPV) of 97.9% (95% CI 96.9 to 98.6). 12-lead ECG assessed by cardiac nurses had a sensitivity of 97.1% (95% CI 89.8 to 99.6), specificity of 100% (95% CI 99.7 to 100), PPV of 100% (95% CI 94.6 to 100) and NPV of 99.8% (95% CI 99.4 to 100).Conclusions Single-lead ECG assessed by radiographers had a moderate sensitivity and PPV but a very high specificity and NPV. Using radiographers may be acceptable for opportunistic screening, in particular if radiographers are thoroughly trained. Thus, 12-lead ECG assessed by cardiac nurses is a potential diagnostic method for the detection of AF.https://openheart.bmj.com/content/6/1/e000942.full
spellingShingle Jes Sanddal Lindholt
Axel Cosmus Pyndt Diederichsen
Lærke Marius Kvist
Nicklas Vinter
Grazina Urbonaviciene
Lars Frost
Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
Open Heart
title Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
title_full Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
title_fullStr Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
title_full_unstemmed Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
title_short Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
title_sort diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
url https://openheart.bmj.com/content/6/1/e000942.full
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