BACKGROUND:Atrial fibrillation (AF) is often asymptomatic and undiagnosed. As AF and hypertension often coexist, opportunistic AF detection during routine automated blood pressure (BP) measurement appears to be an attractive screening method.METHODS:A systematic literature search was conducted to identify studies assessing the diagnostic test accuracy of office, home, or 24-hour ambulatory BP measuring devices with AF detection algorithms versus reference electrocardiography. Analyses were performed per participant (AF status based on several BP readings; most office/home devices) or per reading (AF status based on individual readings; all ambulatory devices). A meta-analysis stratified by device type (office/home/ambulatory) was conducted to calculate pooled measures of diagnostic accuracy. Sensitivity/meta-regression analyses were also performed.RESULTS:Among 3096 records initially retrieved, 23 diagnostic test accuracy studies were included. Data derived from 11 093 individuals (weighted age 69 years, males 56%, hypertensives 79%, diabetics 24%, and AF prevalence 17%) indicated a pooled sensitivity 0.97 (95% CI, 0.92–0.99), specificity 0.93 (95% CI, 0.90–0.95), and accuracy 0.93 (95% CI, 0.89–0.95), with generally consistent results using office, home, or ambulatory BP devices (slightly lower specificity with the latter). The positive and negative predictive values were 0.70 (95% CI, 0.60–0.80) and 0.99 (95% CI, 0.98–1.00), respectively. Sensitivity analyses indicated lower specificity in studies implementing reading versus participant analyses. Most studies presented a low risk of bias and minor applicability concerns.CONCLUSIONS:There is considerable and consistent evidence suggesting high diagnostic accuracy of AF detection algorithms implemented in automated BP monitors during routine BP measurements in and out of the office. AF diagnosis requires verification (electrocardiography) before treatment is administered.

中文翻译：

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常规自动化办公室、家庭和动态血压测量期间的心房颤动筛查：诊断测试准确性系统审查和荟萃分析


背景：心房颤动（AF）通常无症状且未被诊断。由于 AF 和高血压经常共存，因此在常规自动血压 (BP) 测量过程中进行机会性 AF 检测似乎是一种有吸引力的筛查方法。方法：进行系统文献检索，以筛选评估办公室、家庭或 24 小时诊断测试准确性的研究。具有 AF 检测算法的 1 小时动态血压测量设备与参考心电图。对每个参与者（基于多个血压读数的房颤状态；大多数办公室/家庭设备）或每个读数（基于个人读数的房颤状态；所有动态设备）进行分析。进行了按设备类型（办公室/家庭/门诊）分层的荟萃分析，以计算诊断准确性的汇总指标。还进行了敏感性/元回归分析。 结果：在最初检索的 3096 条记录中，纳入了 23 项诊断测试准确性研究。来自 11 093 名个体（加权年龄 69 岁，男性 56%，高血压患者 79%，糖尿病患者 24%，房颤患病率 17%）的数据表明，汇总敏感性为 0.97（95% CI，0.92-0.99），特异性为 0.93（95%） CI，0.90–0.95），准确度 0.93（95% CI，0.89–0.95），使用办公室、家庭或动态血压设备获得的结果总体一致（后者的特异性稍低）。阳性和阴性预测值分别为 0.70 (95% CI, 0.60–0.80) 和 0.99 (95% CI, 0.98–1.00)。敏感性分析表明，与参与者分析相比，实施阅读的研究特异性较低。大多数研究的偏倚风险较低，适用性问题也较小。结论：有大量一致的证据表明，在办公室内外的常规血压测量过程中，自动血压监测仪中实施的 AF 检测算法具有较高的诊断准确性。 AF 诊断需要在治疗前进行验证（心电图）。