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

Bradley M Pitman; Sok-Hui Chew; Christopher X Wong; Amenah Jaghoori; Shinsuke Iwai; Gijo Thomas; Andrew Chew; Prashanthan Sanders; Dennis H Lau

doi:10.2196/24470

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

Bradley M Pitman, Sok-Hui Chew, Christopher X Wong, Amenah Jaghoori, Shinsuke Iwai, Gijo Thomas, Andrew Chew, Prashanthan Sanders, Dennis H Lau

College of Medicine and Public Health

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

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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.

Original language	English
Article number	e24470
Number of pages	10
Journal	JMIR mHealth and uHealth
Volume	9
Issue number	5
DOIs	https://doi.org/10.2196/24470
Publication status	Published - May 2021

Keywords

Atrial fibrillation
Screening
Single-lead ECG
Sub-Saharan Africa

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Pitman, B. M., Chew, S.-H., Wong, C. X., Jaghoori, A., Iwai, S., Thomas, G., Chew, A., Sanders, P., & Lau, D. H. (2021). 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. JMIR mHealth and uHealth, 9(5), Article e24470. https://doi.org/10.2196/24470

@article{6cac362443f046f4a88fca4dfce3cbba,

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",

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.",

keywords = "Atrial fibrillation, Screening, Single-lead ECG, Sub-Saharan Africa",

author = "Pitman, {Bradley M} and Sok-Hui Chew and Wong, {Christopher X} and Amenah Jaghoori and Shinsuke Iwai and Gijo Thomas and Andrew Chew and Prashanthan Sanders and Lau, {Dennis H}",

year = "2021",

month = may,

doi = "10.2196/24470",

language = "English",

volume = "9",

journal = "JMIR mHealth and uHealth",

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}

Pitman, BM, Chew, S-H, Wong, CX, Jaghoori, A, Iwai, S, Thomas, G, Chew, A, Sanders, P & Lau, DH 2021, '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', JMIR mHealth and uHealth, vol. 9, no. 5, e24470. https://doi.org/10.2196/24470

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. / Pitman, Bradley M; Chew, Sok-Hui; Wong, Christopher X et al.
In: JMIR mHealth and uHealth, Vol. 9, No. 5, e24470, 05.2021.

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

TY - JOUR

T1 - Performance of a mobile single-lead electrocardiogram technology for atrial fibrillation screening in a semirural African population

T2 - Insights from “The heart of Ethiopia: Focus on atrial fibrillation” (TEFF-AF) study

AU - Pitman, Bradley M

AU - Chew, Sok-Hui

AU - Wong, Christopher X

AU - Jaghoori, Amenah

AU - Iwai, Shinsuke

AU - Thomas, Gijo

AU - Chew, Andrew

AU - Sanders, Prashanthan

AU - Lau, Dennis H

PY - 2021/5

Y1 - 2021/5

N2 - 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.

AB - 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.

KW - Atrial fibrillation

KW - Screening

KW - Single-lead ECG

KW - Sub-Saharan Africa

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U2 - 10.2196/24470

DO - 10.2196/24470

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C2 - 34009129

AN - SCOPUS:85106460108

SN - 2291-5222

VL - 9

JO - JMIR mHealth and uHealth

JF - JMIR mHealth and uHealth

IS - 5

M1 - e24470

ER -

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

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