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

•National Institute for Health and Care Excellence recommends Microlife WatchBP for atrial fibrillation screening during blood pressure measurement•Meta-analysis showed a sensitivity of 0.98 (95% CI 0.95, 1.00) and specificity 0.92 (0.88, 0.96) for detecting atrial fibrillation with this monitor•Interpretation of blood pressure measurement during atrial fibrillation•Recommendations for screening of atrial fibrillation from scientific societies•Recommendations for atrial fibrillation detection with automated blood pressure measurement.

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 24 h ambulatory BP monitoring showed that AF detected in > 15% of all readings has high probability of AF diagnosis requiring confirmation by 24 h 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.