Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how

Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.We aimed to find the parameters that optimize the diagnostic accuracy of pulse palpation to detect AF. We also aimed to create a simple algorithm for selecting which individuals would benefit fro...

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Autores: Bañeras, Jordi, Pariggiano, Ivana, Rodenas Alesina, Eduard, Oristrell, Gerard, Escalona, Roxana, Miranda, Berta, Rello, Pau, Soriano, Toni, Gordon, Blanca, Belahnech, Yassin, Calabró, Paolo, García Dorado, David, Ferreira González, Ignacio, Radua, Joaquim
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/201042
Acceso en línea:https://hdl.handle.net/2445/201042
Access Level:acceso abierto
Palabra clave:Fibril·lació auricular
Pols (Fisiologia)
Diagnòstic
Atrial fibrillation
Pulse
Diagnosis
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spelling Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and howBañeras, JordiPariggiano, IvanaRodenas Alesina, EduardOristrell, GerardEscalona, RoxanaMiranda, BertaRello, PauSoriano, ToniGordon, BlancaBelahnech, YassinCalabró, PaoloGarcía Dorado, DavidFerreira González, IgnacioRadua, JoaquimFibril·lació auricularPols (Fisiologia)DiagnòsticAtrial fibrillationPulseDiagnosisAtrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.We aimed to find the parameters that optimize the diagnostic accuracy of pulse palpation to detect AF. We also aimed to create a simple algorithm for selecting which individuals would benefit from pulse palpation and, if positive, receive an ECG to detect AF.Nurses from four Cardiology outpatient clinics palpated 7,844 pulses according to a randomized list of arterial territories and durations of measure and immediately followed by a 12-lead ECG, which we used as the reference standard. We calculated the sensitivity and specificity of the palpation parameters. We also assessed whether diagnostic accuracy depended on the nurse's experience or on a list of clinical factors of the patients. With this information, we estimated the positive predictive values and false omission rates according to very few clinical factors readily available in primary care (age, sex, and diagnosis of heart failure) and used them to create the algorithm.The parameters associated with the highest diagnostic accuracy were palpation of the radial artery and classifying as irregular those palpations in which the nurse was uncertain about pulse regularity or unable to palpate pulse (sensitivity = 79%; specificity = 86%). Specificity decreased with age. Neither the nurse's experience nor any investigated clinical factor influenced diagnostic accuracy. We provide the algorithm to select the ≥40 years old individuals that would benefit from a pulse palpation screening: a) do nothing in <60 years old individuals without heart failure; b) do ECG in ≥70 years old individuals with heart failure; c) do radial pulse palpation in the remaining individuals and do ECG if the pulse is irregular or you are uncertain about its regularity or unable to palpate it.Opportunistic screening for AF using optimal pulse palpation in candidate individuals according to a simple algorithm may have high effectiveness in detecting AF in primary care.PLOS2023202320222023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion12 p.application/pdfhttps://hdl.handle.net/2445/201042Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1371/journal.pone.0266955Plos One, 2022, vol. 17, num. 4https://doi.org/10.1371/journal.pone.0266955cc by (c) Bañeras, Jordi et al, 2022http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/2010422026-05-29T05:05:01Z
dc.title.none.fl_str_mv Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how
title Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how
spellingShingle Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how
Bañeras, Jordi
Fibril·lació auricular
Pols (Fisiologia)
Diagnòstic
Atrial fibrillation
Pulse
Diagnosis
title_short Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how
title_full Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how
title_fullStr Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how
title_full_unstemmed Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how
title_sort Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how
dc.creator.none.fl_str_mv Bañeras, Jordi
Pariggiano, Ivana
Rodenas Alesina, Eduard
Oristrell, Gerard
Escalona, Roxana
Miranda, Berta
Rello, Pau
Soriano, Toni
Gordon, Blanca
Belahnech, Yassin
Calabró, Paolo
García Dorado, David
Ferreira González, Ignacio
Radua, Joaquim
author Bañeras, Jordi
author_facet Bañeras, Jordi
Pariggiano, Ivana
Rodenas Alesina, Eduard
Oristrell, Gerard
Escalona, Roxana
Miranda, Berta
Rello, Pau
Soriano, Toni
Gordon, Blanca
Belahnech, Yassin
Calabró, Paolo
García Dorado, David
Ferreira González, Ignacio
Radua, Joaquim
author_role author
author2 Pariggiano, Ivana
Rodenas Alesina, Eduard
Oristrell, Gerard
Escalona, Roxana
Miranda, Berta
Rello, Pau
Soriano, Toni
Gordon, Blanca
Belahnech, Yassin
Calabró, Paolo
García Dorado, David
Ferreira González, Ignacio
Radua, Joaquim
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Fibril·lació auricular
Pols (Fisiologia)
Diagnòstic
Atrial fibrillation
Pulse
Diagnosis
topic Fibril·lació auricular
Pols (Fisiologia)
Diagnòstic
Atrial fibrillation
Pulse
Diagnosis
description Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.We aimed to find the parameters that optimize the diagnostic accuracy of pulse palpation to detect AF. We also aimed to create a simple algorithm for selecting which individuals would benefit from pulse palpation and, if positive, receive an ECG to detect AF.Nurses from four Cardiology outpatient clinics palpated 7,844 pulses according to a randomized list of arterial territories and durations of measure and immediately followed by a 12-lead ECG, which we used as the reference standard. We calculated the sensitivity and specificity of the palpation parameters. We also assessed whether diagnostic accuracy depended on the nurse's experience or on a list of clinical factors of the patients. With this information, we estimated the positive predictive values and false omission rates according to very few clinical factors readily available in primary care (age, sex, and diagnosis of heart failure) and used them to create the algorithm.The parameters associated with the highest diagnostic accuracy were palpation of the radial artery and classifying as irregular those palpations in which the nurse was uncertain about pulse regularity or unable to palpate pulse (sensitivity = 79%; specificity = 86%). Specificity decreased with age. Neither the nurse's experience nor any investigated clinical factor influenced diagnostic accuracy. We provide the algorithm to select the ≥40 years old individuals that would benefit from a pulse palpation screening: a) do nothing in <60 years old individuals without heart failure; b) do ECG in ≥70 years old individuals with heart failure; c) do radial pulse palpation in the remaining individuals and do ECG if the pulse is irregular or you are uncertain about its regularity or unable to palpate it.Opportunistic screening for AF using optimal pulse palpation in candidate individuals according to a simple algorithm may have high effectiveness in detecting AF in primary care.
publishDate 2022
dc.date.none.fl_str_mv 2022
2023
2023
2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/201042
url https://hdl.handle.net/2445/201042
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1371/journal.pone.0266955
Plos One, 2022, vol. 17, num. 4
https://doi.org/10.1371/journal.pone.0266955
dc.rights.none.fl_str_mv cc by (c) Bañeras, Jordi et al, 2022
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Bañeras, Jordi et al, 2022
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 12 p.
application/pdf
dc.publisher.none.fl_str_mv PLOS
publisher.none.fl_str_mv PLOS
dc.source.none.fl_str_mv Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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