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

Europace. 2017 Jan;19(1):29-39. doi: 10.1093/europace/euw025. Epub 2016 Feb 17.


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.

Keywords: Atrial fibrillation; Cost-effectiveness; Electrocardiogram; Handheld ECG; Screening.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Action Potentials*
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / economics
  • Atrial Fibrillation / physiopathology
  • Belgium
  • Cardiology Service, Hospital* / economics
  • Cell Phone* / economics
  • Computer Simulation
  • Cost-Benefit Analysis
  • Electrocardiography / economics
  • Electrocardiography / instrumentation*
  • Equipment Design
  • Female
  • Geriatrics* / economics
  • Heart Conduction System / physiopathology*
  • Heart Rate
  • Hospital Costs
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Mobile Applications
  • Models, Economic
  • Predictive Value of Tests
  • Reproducibility of Results
  • Signal Processing, Computer-Assisted
  • Tertiary Care Centers