Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults: A protocol for a systematic review

Vethanayagam Antony Sheron; Rajendra Surenthirakumaran; Tiffany E. Gooden; Gregory Y. H. Lip; G. Neil Thomas; David J. Moore; Krishnarajah Nirantharakumar; Balachandran Kumarendran; Kumaran Subaschandran; Shribavan Kanesamoorthy; Powsiga Uruthirakumar; Mahesan Guruparan; NIHR Global Health Research Group on Atrial Fibrillation Management

doi:10.1371/journal.pone.0301729

Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults: A protocol for a systematic review

Vethanayagam Antony Sheron, Rajendra Surenthirakumaran, Tiffany E. Gooden, Gregory Y. H. Lip, G. Neil Thomas^*, David J. Moore, Krishnarajah Nirantharakumar, Balachandran Kumarendran^*, Kumaran Subaschandran, Shribavan Kanesamoorthy, Powsiga Uruthirakumar, Mahesan Guruparan, NIHR Global Health Research Group on Atrial Fibrillation Management

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the world. AF increases the risk of stroke 5-fold, though the risk can be reduced with appropriate treatment. Therefore, early diagnosis is imperative but remains a global challenge. In low-and middle-income countries (LMICs), a lack of diagnostic equipment and under-resourced healthcare systems generate further barriers. The rapid development of digital technologies that are capable of diagnosing AF remotely and cost-effectively could prove beneficial for LMICs. However, evidence is lacking on what digital technologies exist and how they compare in regards to diagnostic accuracy. We aim to systematically review the diagnostic accuracy of all digital technologies capable of AF diagnosis.
Methods: MEDLINE, Embase and Web of Science will be searched for eligible studies. Free text terms will be combined with corresponding index terms where available and searches will not be limited by language nor time of publication. Cohort or cross-sectional studies comprising adult (≥18 years) participants will be included. Only studies that use a 12-lead ECG as the reference test (comparator) and report outcomes of sensitivity, specificity, the diagnostic odds ratio (DOR) or the positive and negative predictive value (PPV and NPV) will be included (or if they provide sufficient data to calculate these outcomes). Two reviewers will independently assess articles for inclusion, extract data using a piloted tool and assess risk of bias using the QUADAS-2 tool. The feasibility of a meta-analysis will be determined by assessing heterogeneity across the studies, grouped by index device, diagnostic threshold and setting. If a meta-analysis is feasible for any index device, pooled sensitivity and specificity will be calculated using a random effect model and presented in forest plots.
Discussion: The findings of our review will provide a comprehensive synthesis of the diagnostic accuracy of available digital technologies capable for diagnosing AF. Thus, this review will aid in the identification of which devices could be further trialed and implemented, particularly in a LMIC setting, to improve the early diagnosis of AF.
Trial registration: Systematic review registration: PROSPERO registration number is CRD42021290542. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290542.

Original language	English
Article number	e0301729
Number of pages	9
Journal	PLOS One
Volume	19
Issue number	5
DOIs	https://doi.org/10.1371/journal.pone.0301729
Publication status	Published - 8 May 2024

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SheronV2024Diagnostic.pdfFinal published version, 371 KBLicence: Creative Commons: Attribution (CC BY)

NIHR Global Research Group on Atrial Fibrillation - OPEN FOR DISSEMINATION ONLY
Lasserson, D. (Co-Investigator), Manaseki-Holland, S. (Co-Investigator), Cheng, K. (Co-Investigator), Moore, D. (Co-Investigator), Jolly, K. (Co-Investigator), Greenfield, S. (Co-Investigator), Jowett, S. (Co-Investigator), Brocklehurst, P. (Co-Investigator), Nirantharakumar, K. (Co-Investigator), Szmigin, I. (Co-Investigator), Kirchhof, P. (Co-Investigator), Gough, R. (Co-Investigator) & Thomas, N. (Principal Investigator)
NIHR CENTRAL COMMISSIONING FACILITY
1/04/18 → 30/11/24
Project: Other Government Departments

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Sheron, V. A., Surenthirakumaran, R., Gooden, T. E., Y. H. Lip, G., Thomas, G. N., J. Moore, D., Nirantharakumar, K., Kumarendran, B., Subaschandran, K., Kanesamoorthy, S., Uruthirakumar, P., Guruparan, M., & NIHR Global Health Research Group on Atrial Fibrillation Management (2024). Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults: A protocol for a systematic review. PLOS One, 19(5), Article e0301729. https://doi.org/10.1371/journal.pone.0301729

@article{e04fd61b3cc7452aa8702b641968d35d,

title = "Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults: A protocol for a systematic review",

abstract = "Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the world. AF increases the risk of stroke 5-fold, though the risk can be reduced with appropriate treatment. Therefore, early diagnosis is imperative but remains a global challenge. In low-and middle-income countries (LMICs), a lack of diagnostic equipment and under-resourced healthcare systems generate further barriers. The rapid development of digital technologies that are capable of diagnosing AF remotely and cost-effectively could prove beneficial for LMICs. However, evidence is lacking on what digital technologies exist and how they compare in regards to diagnostic accuracy. We aim to systematically review the diagnostic accuracy of all digital technologies capable of AF diagnosis. Methods: MEDLINE, Embase and Web of Science will be searched for eligible studies. Free text terms will be combined with corresponding index terms where available and searches will not be limited by language nor time of publication. Cohort or cross-sectional studies comprising adult (≥18 years) participants will be included. Only studies that use a 12-lead ECG as the reference test (comparator) and report outcomes of sensitivity, specificity, the diagnostic odds ratio (DOR) or the positive and negative predictive value (PPV and NPV) will be included (or if they provide sufficient data to calculate these outcomes). Two reviewers will independently assess articles for inclusion, extract data using a piloted tool and assess risk of bias using the QUADAS-2 tool. The feasibility of a meta-analysis will be determined by assessing heterogeneity across the studies, grouped by index device, diagnostic threshold and setting. If a meta-analysis is feasible for any index device, pooled sensitivity and specificity will be calculated using a random effect model and presented in forest plots. Discussion: The findings of our review will provide a comprehensive synthesis of the diagnostic accuracy of available digital technologies capable for diagnosing AF. Thus, this review will aid in the identification of which devices could be further trialed and implemented, particularly in a LMIC setting, to improve the early diagnosis of AF. Trial registration: Systematic review registration: PROSPERO registration number is CRD42021290542. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290542.",

author = "Sheron, {Vethanayagam Antony} and Rajendra Surenthirakumaran and Gooden, {Tiffany E.} and {Y. H. Lip}, Gregory and Thomas, {G. Neil} and {J. Moore}, David and Krishnarajah Nirantharakumar and Balachandran Kumarendran and Kumaran Subaschandran and Shribavan Kanesamoorthy and Powsiga Uruthirakumar and Mahesan Guruparan and {NIHR Global Health Research Group on Atrial Fibrillation Management}",

year = "2024",

month = may,

day = "8",

doi = "10.1371/journal.pone.0301729",

language = "English",

volume = "19",

journal = "PLOS One",

issn = "1932-6203",

publisher = "Public Library of Science (PLOS)",

number = "5",

}

Sheron, VA, Surenthirakumaran, R, Gooden, TE , Y. H. Lip, G , Thomas, GN, J. Moore, D, Nirantharakumar, K , Kumarendran, B, Subaschandran, K, Kanesamoorthy, S, Uruthirakumar, P, Guruparan, M & NIHR Global Health Research Group on Atrial Fibrillation Management 2024, 'Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults: A protocol for a systematic review', PLOS One, vol. 19, no. 5, e0301729. https://doi.org/10.1371/journal.pone.0301729

TY - JOUR

T1 - Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults

T2 - A protocol for a systematic review

AU - Sheron, Vethanayagam Antony

AU - Surenthirakumaran, Rajendra

AU - Gooden, Tiffany E.

AU - Y. H. Lip, Gregory

AU - Thomas, G. Neil

AU - J. Moore, David

AU - Nirantharakumar, Krishnarajah

AU - Kumarendran, Balachandran

AU - Subaschandran, Kumaran

AU - Kanesamoorthy, Shribavan

AU - Uruthirakumar, Powsiga

AU - Guruparan, Mahesan

AU - NIHR Global Health Research Group on Atrial Fibrillation Management

PY - 2024/5/8

Y1 - 2024/5/8

N2 - Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the world. AF increases the risk of stroke 5-fold, though the risk can be reduced with appropriate treatment. Therefore, early diagnosis is imperative but remains a global challenge. In low-and middle-income countries (LMICs), a lack of diagnostic equipment and under-resourced healthcare systems generate further barriers. The rapid development of digital technologies that are capable of diagnosing AF remotely and cost-effectively could prove beneficial for LMICs. However, evidence is lacking on what digital technologies exist and how they compare in regards to diagnostic accuracy. We aim to systematically review the diagnostic accuracy of all digital technologies capable of AF diagnosis. Methods: MEDLINE, Embase and Web of Science will be searched for eligible studies. Free text terms will be combined with corresponding index terms where available and searches will not be limited by language nor time of publication. Cohort or cross-sectional studies comprising adult (≥18 years) participants will be included. Only studies that use a 12-lead ECG as the reference test (comparator) and report outcomes of sensitivity, specificity, the diagnostic odds ratio (DOR) or the positive and negative predictive value (PPV and NPV) will be included (or if they provide sufficient data to calculate these outcomes). Two reviewers will independently assess articles for inclusion, extract data using a piloted tool and assess risk of bias using the QUADAS-2 tool. The feasibility of a meta-analysis will be determined by assessing heterogeneity across the studies, grouped by index device, diagnostic threshold and setting. If a meta-analysis is feasible for any index device, pooled sensitivity and specificity will be calculated using a random effect model and presented in forest plots. Discussion: The findings of our review will provide a comprehensive synthesis of the diagnostic accuracy of available digital technologies capable for diagnosing AF. Thus, this review will aid in the identification of which devices could be further trialed and implemented, particularly in a LMIC setting, to improve the early diagnosis of AF. Trial registration: Systematic review registration: PROSPERO registration number is CRD42021290542. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290542.

AB - Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in the world. AF increases the risk of stroke 5-fold, though the risk can be reduced with appropriate treatment. Therefore, early diagnosis is imperative but remains a global challenge. In low-and middle-income countries (LMICs), a lack of diagnostic equipment and under-resourced healthcare systems generate further barriers. The rapid development of digital technologies that are capable of diagnosing AF remotely and cost-effectively could prove beneficial for LMICs. However, evidence is lacking on what digital technologies exist and how they compare in regards to diagnostic accuracy. We aim to systematically review the diagnostic accuracy of all digital technologies capable of AF diagnosis. Methods: MEDLINE, Embase and Web of Science will be searched for eligible studies. Free text terms will be combined with corresponding index terms where available and searches will not be limited by language nor time of publication. Cohort or cross-sectional studies comprising adult (≥18 years) participants will be included. Only studies that use a 12-lead ECG as the reference test (comparator) and report outcomes of sensitivity, specificity, the diagnostic odds ratio (DOR) or the positive and negative predictive value (PPV and NPV) will be included (or if they provide sufficient data to calculate these outcomes). Two reviewers will independently assess articles for inclusion, extract data using a piloted tool and assess risk of bias using the QUADAS-2 tool. The feasibility of a meta-analysis will be determined by assessing heterogeneity across the studies, grouped by index device, diagnostic threshold and setting. If a meta-analysis is feasible for any index device, pooled sensitivity and specificity will be calculated using a random effect model and presented in forest plots. Discussion: The findings of our review will provide a comprehensive synthesis of the diagnostic accuracy of available digital technologies capable for diagnosing AF. Thus, this review will aid in the identification of which devices could be further trialed and implemented, particularly in a LMIC setting, to improve the early diagnosis of AF. Trial registration: Systematic review registration: PROSPERO registration number is CRD42021290542. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290542.

U2 - 10.1371/journal.pone.0301729

DO - 10.1371/journal.pone.0301729

M3 - Article

C2 - 38718097

SN - 1932-6203

VL - 19

JO - PLOS One

JF - PLOS One

IS - 5

M1 - e0301729

ER -

Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults: A protocol for a systematic review

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NIHR Global Research Group on Atrial Fibrillation - OPEN FOR DISSEMINATION ONLY

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