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Int J Cardiol. 2016 Jan 15;203:465-73. doi: 10.1016/j.ijcard.2015.10.182. Epub 2015 Oct 26.

Screening for atrial fibrillation with automated blood pressure measurement: Research evidence and practice recommendations.

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Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands; Microlife AG, Widnau, Switzerland. Electronic address:
Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy.
Hypertension Center STRIDE-7, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.


Several guidelines recommend opportunistic screening for atrial fibrillation (AF) in subjects aged ≥ 65 years using pulse palpation during routine blood pressure (BP) measurement. However, this method has limited diagnostic accuracy. A specific algorithm for AF detection during automated BP measurement was developed and implemented in a novel oscillometric device (Microlife WatchBP Home-A). In 2013, the UK National Institute for Health and Care Excellence (NICE) recommended this device for AF screening during routine office BP measurement in primary care in subjects ≥ 65 years. A review and meta-analysis of the evidence on the diagnostic accuracy of this algorithm were performed. Six studies (n=2332) investigated the accuracy of AF detection using the Microlife BP monitor and estimated a pooled sensitivity at 0.98 (95% CI 0.95, 1.00) and specificity 0.92 (0.88, 0.96). Analysis of 4 studies (n=1126) showed more readings to improve specificity (from 0.86 to 0.91) and sensitivity (from 0.97 to 0.99). Taking 3 sequential readings with at least 2 detecting AF gave the highest diagnostic accuracy. A single study (n=139) of paroxysmal AF screening with home BP monitoring (3316 days) showed sensitivity 99% and specificity 93%. Another study (n=46) of AF screening with 24h ambulatory BP monitoring showed that AF detected in >15% of all readings has high probability of AF diagnosis requiring confirmation by 24h electrocardiography. AF detection with routine automated BP measurement is a reliable screening tool in the elderly, which requires confirmation by electrocardiography. Paroxysmal AF might also be detected by routine automated home or ambulatory BP monitoring.


Arrhythmia; Blood pressure monitoring; Clinic; Home blood pressure; Self-measurement; Stroke

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