Arrhythmias and Conduction Disturbances
Comparison of the Microlife Blood Pressure Monitor With the Omron Blood Pressure Monitor for Detecting Atrial Fibrillation

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Highlights

  • We compared the accuracy of 2 automatic blood pressure monitors for detecting atrial fibrillation (AF).

  • The Microlife monitor had high sensitivity and specificity for AF.

  • The Omron monitor had high specificity but very low sensitivity for AF.

  • The Omron monitor should not be used to screen for AF.

Screening for atrial fibrillation (AF) by assessing the pulse is recommended in high-risk patients. Some clinical trials demonstrated that the Microlife blood pressure monitor (BPM) with AF detection is more accurate than pulse palpation. This led to a change in practice guidelines in the United Kingdom where AF screening with the Microlife device is recommended instead of pulse palpation. Many BPMs have irregular heart beat detection, but they have not been shown to detect AF reliably. Recently, one study, in a highly select population, suggested that the Omron BPM with irregular heart beat detection has a higher sensitivity for AF than the Microlife BPM. We compared the Microlife and Omron BPMs to electrocardiographic readings for AF detection in general cardiology patients. Inclusion criteria were age ≥50 years without a pacemaker or defibrillator. A total of 199 subjects were enrolled, 30 with AF. Each subject had a 12-lead electrocardiography, 1 Omron BPM reading, and 3 Microlife BPM readings as per device instructions. The Omron device had a sensitivity of 30% (95% confidence interval [CI] 15.4% to 49.1%) with the sensitivity for the first Microlife reading of 97% (95% CI 81.4% to 100%) and the Microlife readings using the majority rule (AF positive if at least 2 of 3 individual readings were positive for AF) of 100% (95% CI 85.9% to 100%). Specificity for the Omron device was 97% (95% CI 92.5% to 99.2%) and for the first Microlife reading of 90% (95% CI 83.8% to 94.2%) and for the majority rule Microlife device of 92% (95% CI 86.2% to 95.7%; p <0.0001). The specificity of both devices is acceptable, but only the Microlife BPM has a sensitivity value that is high enough to be used for AF screening in clinical practice.

Section snippets

Methods

The study population included all patients aged ≥50 years in 2 outpatient cardiology clinics, who agreed to be enrolled in the trial. Patients with pacemakers or defibrillators were excluded from the study. The tested BPMs were the Omron M6 Comfort (HEM-7223-E; Omron Healthcare Co., Ltd., Kyoto, Japan) and the Microlife BP A 200 (Microlife Corp., Taipei, Taiwan).

A technician obtained a 12-lead electrocardiogram and then took the blood pressure and AF readings using both the Omron and Microlife

Results

There were 199 subjects enrolled in the study, of which 183 fulfilled all the inclusion criteria. The 16 subjects who did not meet the enrollment criteria were aged <50 years. AF readings for 99.5% of the subjects were recorded for both the Omron and Microlife devices. Demographic and medical history for the subjects who met the enrollment criteria are listed in Table 1. The age of the subjects is typical for those with AF. Subjects with a history of AF did not necessarily have AF on the

Discussion

The Omron M6 BPM with irregular heart beat detection had a very low sensitivity for detecting AF. The results for the Microlife monitor confirm the results of previous studies performed in medical clinics that demonstrated a sensitivity of 93% to 100% and a specificity of 86% to 93% for detecting AF.10, 11, 12 This high sensitivity makes the Microlife device a good choice for screening for AF in the clinic setting. Screening and early treatment of AF is likely to reduce the risk of stroke,

Disclosures

Dr. Wiesel has a patent for the atrial fibrillation algorithm, which is licensed to Microlife Corp. There are no other potential conflicts of interest relevant to this study.

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This study was funded by Microlife Corporation, Taipei, Taiwan.

See page 1048 for disclosure information.

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