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.
- atrial fibrillation
- diagnostic accuracy
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Contributors GU, JSL, ACD and LF participated in the original planning, conduct and design of the study. LMK, NV and LF performed the data analysis. LMK, NV, GU, JSL, ACD and LF participated in the interpretation of data, as well as the drafting and critical review of the paper. LMK and LF take responsibility for the overall content as guarantors.
Funding This work was supported by the Region of Southern Denmark, the Danish Heart Foundation, the Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), the Odense University Hospital, and the Free National Research Councils and Helsefonden. The CT scan and room facilities were provided by the Silkeborg Regional Hospital.
Competing interests LF has been a member of the advisory boards for BMS and Pfizer, and has received speaker fees from Bayer, BMS, Boehringer Ingelheim, MSD and Pfizer.
Patient consent for publication Not required.
Ethics approval The study was approved by the Southern Denmark Region Committee on Biomedical Research Ethics (S-20140028) and the Data Protection Agency (S-20160164). Informed consent was obtained from all participants.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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