title: Differences in Clinical and Functional Outcomes of Atrial Fibrillation in Women and Men: Two-Year Results From the ORBIT-AF Registry. The diagnostic accuracy of the MyDiagnostick to detect atrial fibrillation in primary care
abstract: IMPORTANCE Despite the frequency of  atrial fibrillation ( AF )  in clinical practice , relatively little is known about sex differences in symptoms and quality of life and how they may affect treatment and outcomes . OBJECTIVE To determine whether symptoms , quality of life , treatment , and outcomes differ between women and men with AF . DESIGN , SETTING , AND PARTICIPANTS This observational cohort study included 10 135 patients with AF . The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation is a prospect i ve , nationwide , multicenter outpatient registry of patients with incident and prevalent AF enrolled at 176 sites between June 2010 and August 2011 . MAIN OUTCOMES AND MEASURES Symptoms , quality of life as measured by Atrial Fibrillation Effects on Quality of Life scores , AF treatment , cardiovascular outcomes , stroke or non- central nervous system embolism , and all-cause mortality . RESULTS Overall , 4293 of the cohort ( 42 % ) were female . Compared with men , women were older ( 77 years ; interquartile range [ IQR ] , 69 - 83 , vs 73 years ; IQR , 65 - 80 ; P < .001 ) and had higher median CHA2DS2-VASc scores ( 5 ; IQR , 4 - 6 , vs 3 ; IQR , 2 - 5 ; P < .001 ) , but less sleep apnea ( 578 [ 13.5 % ] vs 1264 [ 21.6 % ] ; P < .001 ) . Only 32.1 % of women ( n = 1378 ) were asymptomatic ( European Heart Rhythm Association class I ) compared with 42.5 % of men ( n = 2483 ) in unadjusted analyses ( P < .001 ) . Women had lower ( more severe ) unadjusted baseline overall Atrial Fibrillation Effects on Quality of Life scores ( n = 2007 ; 80 ; IQR , 62 - 92 vs 83 ; IQR , 69 - 94 ; P < .001 ) . Women had similar rates of anticoagulation and similar time in therapeutic range . In follow-up , women experienced lower risk-adjusted all-cause mortality ( adjusted hazard ratio , 0.57 ; 95 % CI , 0.49 - 0.67 ) and cardiovascular death ( adjusted hazard ratio , 0.56 ; 95 % CI , 0.44 - 0.72 ) ; however , they had a higher risk for stroke or non- central nervous system embolism ( adjusted hazard ratio , 1.39 ; 95 % CI , 1.05 - 1.84 ; P = .02 ) compared with men . CONCLUSIONS AND RELEVANCE Women with AF have more symptoms and worse quality of life . Despite higher risk , women have lower risk-adjusted all-cause and cardiovascular death compared with men , but higher stroke rates . Future studies should focus on how treatment and interventions specifically affect AF-related quality of life and cardiovascular outcomes in women . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01165710 Background Atrial fibrillation is very common in people aged 65 or older . This condition increases the risk of death , congestive heart failure and thromboembolic conditions . Many patients with atrial fibrillation are asymptomatic and a cerebrovascular accident ( CVA ) is often the first clinical presentation . Guidelines concerning the prevention of CVA recommend monitoring the heart rate in patients aged 65 or older . Recently , the MyDiagnostick ( Applied Biomedical Systems BV , Maastricht , The Netherl and s ) was introduced as a new screening tool which might serve as an alternative for the less accurate pulse palpation . This study was design ed to explore the diagnostic accuracy of the MyDiagnostick for the detection of atrial fibrillation . Methods A phase II diagnostic accuracy study in a convenience sample of 191 subjects recruited in primary care . The majority of participants were patients with a known history of atrial fibrillation ( n = 161 ) .  Readings of the MyDiagnostick were compared with electrocardiographic recordings . Sensitivity and specificity and their 95 % confidence interval were calculated using 2x2 tables . Results A prevalence of 54 % for an atrial fibrillation rhythm was found in the study population at the moment of the study . A combination of three measurements with the MyDiagnostick for each patient showed a sensitivity of 94 % ( 95 % CI 87 – 98 ) and a specificity of 93 % ( 95 % CI 85 – 97 ) . Conclusion The MyDiagnostick is an easy-to-use device that showed a good diagnostic accuracy with a high sensitivity and specificity for atrial fibrillation in a convenience sample in primary care . Future research is needed to determine the place of the MyDiagnostick in possible screening or case-finding strategies for atrial fibrillation
target: Kardia Mobile is the most cost effective option in a full incremental analysis .
  Lead-I ECG tests may identify more AF cases than the st and ard diagnostic pathway .
  This comes at a higher cost but with greater patient benefit in terms of mortality and quality of life .
  Conclusions The use of single-time point lead-I ECG devices in primary care for the detection of AF in people with signs or symptoms of AF and an irregular pulse appears to be a cost effective use of NHS re sources compared with MPP followed by a 12-lead ECG , given the assumptions used in the base case model .
background: Background Atrial fibrillation ( AF ) is the most common type of cardiac arrhythmia and is associated with increased risk of stroke and congestive heart failure .
  Lead-I electrocardiogram ( ECG ) devices are h and held instruments that can detect AF at a single-time point .
  Purpose To assess the diagnostic test accuracy , clinical impact and cost effectiveness of single-time point lead-I ECG devices compared with manual pulse palpation ( MPP ) followed by a 12-lead ECG for the detection of AF in symptomatic primary care patients with an irregular pulse .