Authors' objectives: HTW undertook an evidence review to address the following questions: 1) What is the diagnostic accuracy of handheld single lead electrocardiograms for the detection of atrial fibrillation?; 2) What is the effectiveness of handheld single lead electrocardiogram devices in single point of time screening for unknown atrial fibrillation in people aged over 65 in primary care and the community; 3) What is the effectiveness of handheld single lead electrocardiogram devices to detect intermittent atrial fibrillation after an inconclusive clinical examination?

Authors' results and conclusions: HTW identified and included two systematic reviews on the diagnostic accuracy of lead-I ECG (single lead electrocardiogram), nine primary studies and four economic evaluations examining effectiveness or cost-effectiveness of lead-I ECG in screening for unknown AF (atrial fibrillation), and two primary studies examining effectiveness in detection of intermittent AF. Several further studies relating to organisational and patient issues also informed the report. For screening for unknown AF, three distinct approaches to screening were found in the included (during usual contacts or influenza vaccination clinics in primary care, or in community-based pharmacies). The evidence suggests that screening with lead-I ECG is able to identify limited number of unknown cases of AF and small numbers of patients had treatment initiated as a result. When studies compared screening with lead-I ECG to pulse palpitation, the results suggested that the approaches were equivalent and lead-I ECG was not shown to be more beneficial. Few studies examined outcomes beyond identification of AF and there was limited evidence on longer-term benefits and harms associated with lead-I ECG screening. Available economic evidence suggested there was a potential for lead-I ECG to deliver value when compared to no screening, but value was less clear when compared to screening with pulse palpitation. For detection of intermittent AF in people with inconclusive clinical examinations, a randomised controlled trial suggested that use of lead-I ECG can identify additional cases and reduce time to diagnosis. These results were replicated even when all participants received both lead-I ECG and 24-hour Holter monitoring. However, studies were limited by short-term follow-up and were not able to provide evidence on whether increased and quicker diagnosis reduces serious health outcomes and mortality for this population. No economic evidence was identified in this setting.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

URL for project: https://healthtechnology.wales/reports-guidance/handheld-single-lead-electrocardiogram-devices/

Year Published: 2021

URL for published report: https://healthtechnology.wales/wp-content/uploads/2021/05/EAR028-Lead-I-ECG.pdf

URL for additional information: https://healthtechnology.wales/reports-guidance/handheld-single-lead-electrocardiogram-devices/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk

Copyright: Health Technology Wales