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Cardiac risk factors and prevention
Original research article
Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
  1. Lærke Marius Kvist1,
  2. Nicklas Vinter1,2,
  3. Grazina Urbonaviciene1,2,
  4. Jes Sanddal Lindholt3,
  5. Axel Cosmus Pyndt Diederichsen4 and
  6. Lars Frost5
  1. 1 Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark
  2. 2 Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
  3. 3 Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Odense Universitetshospital, Odense, Denmark
  4. 4 Department of Cardiology, Odense University Hospital, Odense, Denmark
  5. 5 Department of Medicine, Silkeborg Regional Hospital and Cardiovascular Research Centre Viborg and Silkeborg Hospital and Institute of Clinical Medicine, Aarhus University Hospital Denmark, Silkeborg, Denmark
  1. Correspondence to Dr Lærke Marius Kvist; mariuskvist{at}gmail.com

Abstract

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
  • electrocardiography
  • screening

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2018-000942

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    Footnotes

    • 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.