Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/131505
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Type: Journal article
Title: Performance of a mobile single-lead electrocardiogram technology for atrial fibrillation screening in a semirural African population: insights from "The Heart of Ethiopia: Focus on Atrial Fibrillation" (TEFF-AF) study
Author: Pitman, B.M.
Chew, S.-H.
Wong, C.X.
Jaghoori, A.
Iwai, S.
Thomas, G.
Chew, A.
Sanders, P.
Lau, D.H.
Citation: JMIR mHealth and uHealth, 2021; 9(5):e24470-1-e24470-10
Publisher: JMIR Publications
Issue Date: 2021
ISSN: 2291-5222
2291-5222
Statement of
Responsibility: 
Bradley M Pitma, Sok-Hui, Christopher X Wong, Amenah Jaghoori, Shinsuke Iwai, Gijo Thomas ... et al.
Abstract: BACKGROUND: Atrial fibrillation (AF) screening using mobile single-lead electrocardiogram (ECG) devices has demonstrated variable sensitivity and specificity. However, limited data exists on the use of such devices in low-resource countries. OBJECTIVE: The goal of the research was to evaluate the utility of the KardiaMobile device's (AliveCor Inc) automated algorithm for AF screening in a semirural Ethiopian population. METHODS: Analysis was performed on 30-second single-lead ECG tracings obtained using the KardiaMobile device from 1500 TEFF-AF (The Heart of Ethiopia: Focus on Atrial Fibrillation) study participants. We evaluated the performance of the KardiaMobile automated algorithm against cardiologists' interpretations of 30-second single-lead ECG for AF screening. RESULTS: A total of 1709 single-lead ECG tracings (including repeat tracing on 209 occasions) were analyzed from 1500 Ethiopians (63.53% [953/1500] male, mean age 35 [SD 13] years) who presented for AF screening. Initial successful rhythm decision (normal or possible AF) with one single-lead ECG tracing was lower with the KardiaMobile automated algorithm versus manual verification by cardiologists (1176/1500, 78.40%, vs 1455/1500, 97.00%; P<.001). Repeat single-lead ECG tracings in 209 individuals improved overall rhythm decision, but the KardiaMobile automated algorithm remained inferior (1301/1500, 86.73%, vs 1479/1500, 98.60%; P<.001). The key reasons underlying unsuccessful KardiaMobile automated rhythm determination include poor quality/noisy tracings (214/408, 52.45%), frequent ectopy (22/408, 5.39%), and tachycardia (>100 bpm; 167/408, 40.93%). The sensitivity and specificity of rhythm decision using KardiaMobile automated algorithm were 80.27% (1168/1455) and 82.22% (37/45), respectively. CONCLUSIONS: The performance of the KardiaMobile automated algorithm was suboptimal when used for AF screening. However, the KardiaMobile single-lead ECG device remains an excellent AF screening tool with appropriate clinician input and repeat tracing. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001107112; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378057&isReview=true.
Keywords: atrial fibrillation
screening
single-lead ECG
sub-Saharan Africa
Rights: © Bradley M Pitman, Sok-Hui Chew, Christopher X Wong, Amenah Jaghoori, Shinsuke Iwai, Gijo Thomas, Andrew Chew, Prashanthan Sanders, Dennis H Lau. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 19.05.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on https://mhealth.jmir.org/, as well as this copyright and license information must be included.
DOI: 10.2196/24470
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