MyDiagnostick delivers reliable AF screening even by nonspecialists

The atrial fibrillation (AF) screening tool, MyDiagnostick, demonstrates comparable sensitivity and specificity with manual pulse checking, validated across studies performed in a multiethnic Asian population, according to a Singapore study. Of note, AF prevalence in this cohort is similar to that in other countries.

“MyDiagnostick is a simple AF screening device that can be reliably used by nonspecialist professionals in the community setting,” the researchers said.

This prospective single-centre study compared MyDiagnostick with manual pulse check for AF screening in the community setting. In 2014, members of the public were invited for AF screening over 5 days in a single institution. All candidates filled up a questionnaire, which included demographics, medical history, and symptoms. No patient identifiers were recorded.

Participants had a manual pulse check of at least 15 seconds, carried out by nurses, and were also screened with MyDiagnostick. Those who either had an abnormal pulse or MyDiagnostick findings underwent a single-lead electrocardiography (ECG) rhythm strip. A cardiologist then interpreted the findings.

Of the 671 participants from a multiethnic Asian population, 12 (1.78 percent) were found to have AF; six of them had a previous history of AF while the rest were newly diagnosed with AF. Participants with AF were older (72.0 vs 56.0 years; p<0.0001) and had higher CHADSVASC risk score (2.9 vs 1.5; p=0.0001). [Singapore Med J 2022;doi:10.11622/smedj.2022028]

The sensitivity and the specificity of MyDiagnostick were 100 percent and 96.2 percent, respectively. On the other hand, manual pulse check had a sensitivity of 83.3 percent and a specificity of 98.9 percent.

Cardiologists referred patients with newly diagnosed AF to their family physician with a copy of the ECG rhythm strip tracing of AF. Those who already had AF were then reminded to continue their follow-up with their physicians.

In an earlier study, MyDiagnostick demonstrated a sensitivity of 94 percent (95 percent confidence interval, 87‒98) and a specificity of 93 percent (95 percent CI, 85‒97) in a primary care setting with most patients known to have AF. [BMC Fam Pract 2014;15:113]

In another study, the screening tool was used in a cohort of patients with a lower AF prevalence. It had a sensitivity of 95 percent (95 percent CI, 93‒100), and a specificity of 95.9 percent (95 percent CI, 91.3‒98.1). [Europace 2014;16:1291-1295]

“As an AF screening tool, it would be difficult to justify MyDiagnostick as a cost-effective tool compared with manual pulse check,” the researchers said. “However, a manual pulse check is less likely to be available in the general community without first training patients or the screeners to differentiate a regular from an irregular pulse.”

In the current study, registered nurses performed the manual pulse check, while nonmedical personnel administered the MyDiagnostick.

Limitations of this study included a possible biased population, its single-centre design, and potential inaccuracies in the medical histories of candidates.