Performance of handheld electrocardiogram devices to detect atrial fibrillation in a cardiology and geriatric ward setting.

AIMS: To determine the usability, accuracy, and cost-effectiveness of two handheld single-lead electrocardiogram (ECG) devices for atrial fibrillation (AF) screening in a hospital population with an increased risk for AF. METHODS AND RESULTS: Hospitalized patients (n = 445) at cardiological or geriatric wards were screened for AF by two handheld ECG devices (MyDiagnostick and AliveCor). The performance of the automated algorithm of each device was evaluated against a full 12-lead or 6-lead ECG recording. All ECGs and monitor tracings were also independently reviewed in a blinded fashion by two electrophysiologists. Time investments by nurses and physicians were tracked and used to estimate cost-effectiveness of different screening strategies. Handheld recordings were not possible in 7 and 21.4% of cardiology and geriatric patients, respectively, because they were not able to hold the devices properly. Even after the exclusion of patients with an implanted device, sensitivity and specificity of the automated algorithms were suboptimal (Cardiology: 81.8 and 94.2%, respectively, for MyDiagnostick; 54.5 and 97.5%, respectively, for AliveCor; Geriatrics: 89.5 and 95.7%, respectively, for MyDiagnostick; 78.9 and 97.9%, respectively, for AliveCor). A scenario based on automated AliveCor evaluation in patients without AF history and without an implanted device proved to be the most cost-effective method, with a provider cost to identify one new AF patient of €193 and €82 at cardiology and geriatrics, respectively. The cost to detect one preventable stroke per year would be €7535 and €1916, respectively (based on average CHA2DS2-VASc of 3.9 ± 2.0 and 5.0 ± 1.5, respectively). Manual interpretation increases sensitivity, but decreases specificity, doubling the cost per detected patient, but remains cheaper than sole 12-lead ECG screening. CONCLUSION: Using AliveCor or MyDiagnostick handheld recorders requires a structured screening strategy to be effective and cost-effective in a hospital setting. It must exclude patients with implanted devices and known AF, and requires targeted additional 12-lead ECGs to optimize specificity. Under these circumstances, the expenses per diagnosed new AF patient and preventable stroke are reasonable.

Knowledge gaps in patients with atrial fibrillation revealed by a new validated knowledge questionnaire.

OBJECTIVE: The aim of this study was to develop and validate a new questionnaire, the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ), to test the knowledge of patients with atrial fibrillation (AF) about the arrhythmia, its treatment and their ability for self-management. METHODS: The JAKQ was developed based on other questionnaires, two educational checklists and patient information support websites. The JAKQ was validated based on content validity, face validity, response process, discriminatory potential and sensitivity of the questionnaire, construct validity and reliability. It was presented to both outpatients and hospitalised patients. RESULTS: A total of 466 AF patients completed the JAKQ. The final 16-item JAKQ consists of 8 questions about AF in general, 5 questions about oral anticoagulation (OAC) therapy and either 3 questions about vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC). The questionnaire is completed in 6.5±2.4min. The mean score on the JAKQ is 55.8±18.6% with a wide discriminatory span of scores. The JAKQ reveals important knowledge gaps, like 28.8% of the patients not being aware of their medical condition named 'atrial fibrillation', 33.7% being unaware that AF can cause thromboembolism and stroke, and 78.6% of the patients taking VKA and 57.0% of the patients on NOACs not knowing what to do when missing an OAC dose. CONCLUSIONS: The JAKQ is a brief, complete and valid AF-specific knowledge questionnaire that can be used in daily practice to assess patients' insight into their condition. It could be used as a tool for individually tailored patient education.