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Diagnostic Accuracy of a Smartphone-Operated Single-Lead ECG for Detection of Rhythm and Conduction Abnormalities in Primary Care

Divya Manda and Michael E Johansen
The Annals of Family Medicine September 2019, 17 (5) iii; DOI: https://doi.org/10.1370/afm.2458

The Annals of Family Medicine encourages readers to develop a diverse learning community to think critically about important issues affecting primary care, conduct journal clubs, and act on those discussions.1

HOW IT WORKS

In each issue, the Annals selects an article and provides discussion tips and questions. Post a summary of your conversation in our online discussion. (Open the article and click on “TRACK Discussion/ Submit a comment.”) Discussion questions and information are online at: http://www.AnnFamMed.org/site/AJC/.

CURRENT SELECTION

Article for Discussion

Himmelreich JC, Karregat EP, Lucassen WA, et al. Diagnostic accuracy of a smartphone-operated, single-lead ECG for detection of rhythm and conduction abnormalities in primary care. Ann Fam Med. 2019; 17( 5): 403- 411.OpenUrlAbstract/FREE Full Text

Discussion Tips

Many patients present to primary care physicians with symptoms that are suspicious for cardiac arrhythmias, but 12-lead ECGs to evaluate the symptoms are not always available or are cumbersome. This article describes a blinded case series to evaluate the utility of a smartphone-enabled 1-lead ECG.

Discussion Questions

  • What does this study investigate and why does this matter?

  • How is this study different from previous studies about smartphone-enabled ECGs? What does this study add to the field?

  • How strong is the study design to answer the researchers’ questions?

  • Define sensitivity, specificity, likelihood ratios, positive/ negative predictive value. How are these calculated?

    • What are some criticisms about the use of these values?2,3

  • What were the primary and secondary findings of the study? How accurate was 1-lead ECG for detecting atrial fibrillation/atrial flutter vs other arrhythmias vs ectopic beats? Is there value in combining these end points?

    • Importantly, what does this study not investigate?

  • To what degree can the findings be accounted for by:

    • How patients were selected, excluded, or lost to follow-up; how the main variables were measured?; confounding variables; and how the findings were interpreted?

  • How applicable are the study results to your patient population? How applicable are the study results in a typical primary care office? What is the transportability of the findings?

  • How might spectrum bias be relevant to this study?

  • How might the study change your practice? Would you be more likely to use a smartphone-enabled 1-lead ECG in your office or at home visits?

  • What are the limitations of the study and how may this limit the applicability of the results?

  • How does this study relate to and differ from the discussion around using smartphone ECG as a screening tool?4

  • What are next steps in applying the findings to clinical practice and in primary care?

  • What research questions remain regarding the use of smartphone-enabled 1-lead ECGs in primary care?

References

  1. ↵
    1. Stange KC,
    2. Miller WL,
    3. McLellan LA,
    4. et al
    . Annals Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. http://annfammed.org/cgi/content/full/4/3/196.
    OpenUrlFREE Full Text
  2. ↵
    1. Janssens AC,
    2. Deng Y,
    3. Borsboom GJ,
    4. Eijkemans MJ,
    5. Habbema JD,
    6. Steyerberg EW
    . A new logistic regression approach for the evaluation of diagnostic test results. Med Decis Making. 2005; 25(2): 168-177.
    OpenUrlCrossRefPubMed
  3. ↵
    1. McNutt R,
    2. Hadler NM
    . Rethinking our thinking about diagnostic tests: there is nothing positive or negative about a test result. https://thehealthcareblog.com/blog/2015/12/01/rethinking-about-diagnostic-tests-there-is-nothing-positive-or-negative-about-a-test-result/. Accessed Aug 9, 2019.
  4. ↵
    1. Mandrola J,
    2. Foy A
    . Downsides of detecting atrial fibrillation in asymptomatic patients. Am Fam Physician. 2019; 99(6): 354-355.
    OpenUrl
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