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Open Heart. 2019 Mar 1;6(1):e000942. doi: 10.1136/openhrt-2018-000942. eCollection 2019.

Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers.

Author information

Diagnostic Centre, Regionshospitalet Silkeborg, Silkeborg, Denmark.
Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark.
Department of Cardiothoracic and Vascular Surgery, Elitary Research Centre of Individualized Medicine in Arterial Diseases (CIMA), Odense Universitetshospital, Odense, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Department of Medicine, Silkeborg Regional Hospital and Cardiovascular Research Centre Viborg and Silkeborg Hospital and Institute of Clinical Medicine, Aarhus University Hospital Denmark, Silkeborg, Denmark.



We examined the diagnostic accuracy of single-lead ECG as assessed by radiographers and 12-lead ECG as assessed by cardiac nurses for the diagnosis of atrial fibrillation (AF).


Based on the Danish Cardiovascular Screening Trial, we conducted a population-based, cross-sectional study of 1338 randomly selected Danish men aged 65-74 years with no exclusion criteria. The participants were screened with single-lead ECG during a CT scan assessed by radiographers and 12-lead ECG assessed by cardiac nurses. The diagnostic accuracy was evaluated compared with that produced by a 12-lead ECG assessed by two consenting cardiologists.


The study identified 68 participants with ongoing AF, of whom 60 had self-reported AF and 8 had AF detected in the screening. Single-lead ECG assessed for AF by radiographers had a sensitivity of 60.3% (95% CI 47.7 to 72.0), specificity of 97.2% (95% CI 96.2 to 98.1), positive predictive value (PPV) of 53.9% (95% CI 42.1 to 65.5) and negative predictive value (NPV) of 97.9% (95% CI 96.9 to 98.6). 12-lead ECG assessed by cardiac nurses had a sensitivity of 97.1% (95% CI 89.8 to 99.6), specificity of 100% (95% CI 99.7 to 100), PPV of 100% (95% CI 94.6 to 100) and NPV of 99.8% (95% CI 99.4 to 100).


Single-lead ECG assessed by radiographers had a moderate sensitivity and PPV but a very high specificity and NPV. Using radiographers may be acceptable for opportunistic screening, in particular if radiographers are thoroughly trained. Thus, 12-lead ECG assessed by cardiac nurses is a potential diagnostic method for the detection of AF.


atrial fibrillation; diagnostic accuracy; electrocardiography; screening

Conflict of interest statement

Competing interests: LF has been a member of the advisory boards for BMS and Pfizer, and has received speaker fees from Bayer, BMS, Boehringer Ingelheim, MSD and Pfizer.

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