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Diagnostic accuracy of handheld electrocardiogram devices in detecting atrial fibrillation in adults in community versus hospital settings: a systematic review and meta-analysis
  1. Kam Cheong Wong1,2,3,4,
  2. Harry Klimis1,2,5,
  3. Nicole Lowres6,
  4. Amy von Huben1,
  5. Simone Marschner1,
  6. Clara K Chow1,2,5,6
  1. 1 Westmead Applied Research Centre, The University of Sydney, Westmead, New South Wales, Australia
  2. 2 Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, New South Wales, Australia
  4. 4 School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange, New South Wales, Australia
  5. 5 Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
  6. 6 Heart Research Institute, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Kam Cheong Wong, Westmead Applied Research Centre, The University of Sydney, Westmead, NSW 2145, Australia; kam.wong{at}


With increasing use of handheld ECG devices for atrial fibrillation (AF) screening, it is important to understand their accuracy in community and hospital settings and how it differs among settings and other factors. A systematic review of eligible studies from community or hospital settings reporting the diagnostic accuracy of handheld ECG devices (ie, devices producing a rhythm strip) in detecting AF in adults, compared with a gold standard 12-lead ECG or Holter monitor, was performed. Bivariate hierarchical random-effects meta-analysis and meta-regression were performed using R V.3.6.0. The search identified 858 articles, of which 14 were included. Six studies recruited from community (n=6064 ECGs) and eight studies from hospital (n=2116 ECGs) settings. The pooled sensitivity was 89% (95% CI 81% to 94%) in the community and 92% (95% CI 83% to 97%) in the hospital. The pooled specificity was 99% (95% CI 98% to 99%) in the community and 95% (95% CI 90% to 98%) in the hospital. Accuracy of ECG devices varied: sensitivity ranged from 54.5% to 100% and specificity ranged from 61.9% to 100%. Meta-regression showed that setting (p=0.032) and ECG device type (p=0.022) significantly contributed to variations in sensitivity and specificity. The pooled sensitivity and specificity of single-lead handheld ECG devices were high. Setting and handheld ECG device type were significant factors of variation in sensitivity and specificity. These findings suggest that the setting including user training and handheld ECG device type should be carefully reviewed.

  • atrial fibrillation
  • electrocardiography
  • eHealth/telemedicine/mobile health

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  • Correction notice Since the online publication of this article, Figure 4 has been replaced with a higher quality version.

  • Contributors All authors were involved in the conceptualisation and design of the review. KCW established the search strategies with assistance from an academic librarian. KCW and HK screened the titles, abstracts and full articles as per the protocol. KCW, HK and NL assessed the quality of the included studies. KCW, AvH and SM analysed the data. All authors discussed the findings. KCW drafted the manuscript, and all authors reviewed, discussed, revised and approved the manuscript for publication.

  • Funding There is no funding to perform this systematic review and meta-analysis. However, the following coauthors were supported by their fellowships: HK is supported by a Royal Australasian College of Physicians (RACP) Fellows Research Entry Scholarship. NL is supported by an NSW Health Early Career Fellowship (H16/ 52168). CKC is supported by an NHMRC Career Development Fellowship (App1105447, cofunded by a National Heart Foundation Future Leader Fellowship).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.