Screening tests of atrial fibrillation with single-channel portable ECG apparatus

V raziskavi smo ugotavljali diagnostično vrednost enokanalnega prenosnega EKG monitorja HCG 801 pri klasifikaciji atrijske fibrilacije (AF). Namen raziskovalnega dela je bil raziskati njegovo učinkovitost pri presejalnem testu AF na primarni ravni v patronažnem varstvu. Raziskovalna metodologija. Raziskava je temeljila na kvantitativni metodologiji, kjer smo uporabili statistično metodo diagnostičnega testa. Z uporabo kontingenčnih tabel smo izračunali statistične vrednosti za specifičnost, senzitivnost, pozitivno napovedano vrednost in negativno napovedano vrednost. V raziskavo diagnostične vrednosti prenosnega EKG monitorja smo vključili 63 bolnikov z diagnosticirano AF in 62 bolnikov brez diagnosticirane AF. Bolniki, ki se zdravijo v antikoagulantni ambulanti, so imeli že potrjeno AF. Bolnike brez diagnosticirane AF smo zagotovili z vključevanjem kroničnih bolnikov na terenskem območju patronažnih sester. Na terenu smo vsem preiskovancem posneli 12-kanalni EKG, ki nam je služil za potrditev ali zavrnitev diagnoze AF. Na skupnem vzorcu 125 bolnikov smo nato izvedli meritve z enokanalnim EKG monitorjem, izpis pa sta odčitavala dva zdravnika in tri patronažne medicinske sestre. Raziskovalni vzorec na terenu nam je pozneje služi za presejalni test AF. Rezultati. Rezultati so pokazali, da sta oba zdravnika in vse tri patronažne medicinske sestre dosegli, visoko specifičnost in senzitivnost pri odkrivanju AF z enokanalnim prenosnim EKG monitorjem. Zdravnika sta diagnosticirala AF s senzitivnostjo 83,6 % (Cl = 72,9–90,6 %) in 82,1 % (Cl = 71,3–89,4 %). Specifičnost diagnostičnega testa je bila 88,7 % (Cl = 77,4–94,7 %) in 79,2 % (Cl = 66,5–88,0 %). Patronažne medicinske sestre so dosegle senzitivnost testa 79,1 % (Cl = 67,9– 87,1 %), 80,6 % (Cl = 69,6–88,3 %) in 77,6 % (Cl = 66,3–85,9 %). Specifičnosti diagnostičnega testa pri patronažnih medicinskih sestrah so bile prav tako visoke: 86,8 % (Cl = 75,2–93,5 %), 84,9 % (Cl = 72,9–92,1 %) in 83,0 % (Cl = 70,8–90,8 %). S presejalnim testom, kjer smo uporabljali prenosni EKG monitor, smo na vzorcu 60 preiskovancev odkrili 7 primerov atrijske fibrilacije (incidenca 12 %). Sklep. Analiza rezultatov nakazuje, da je prenosni EKG monitor učinkovito orodje pri presejanju atrijske fibrilacije na terenu.In the master’s thesis we focused on determining the diagnostic value of the single-channel portable ECG monitor HCG 801 for atrial fibrillation classification (AF). The purpose of this experiment was to determine the efficiency of this method with AF screening tests on the primary level of home care nursing. Research methodology. The research was based on quantitative methodology, where we used the statistical method of diagnostic testing. By the help of contingency tables, we were able to calculate the values of specificity, sensitivity, positive and negative prediction value. In order to determine the diagnostic value of the portable ECG monitor, we added 63 patients diagnosed with AF and 62 patients without AF into the experiment. Patients being treated in the anticoagulation clinic have already had their AF confirmed. We managed to include patients not diagnosed with AF by adding chronic patients from operational areas of home care nurses. On the field we executed a 12 channel ECG test on each subject, by which we were able to determine a positive or negative diagnosis of AF. We then carried out measurements on the common sample of 125 patients with the help of a single-channel ECG monitor. The print-outs were monitored by two doctors and three home care nurses. The onfield research model was later used as an AF screening test. Results. The results showed, that both doctors and all three home care nurses achieved a high AF diagnostic value with the single-channel portable ECG apparatus. The doctors diagnosed AF with a sensitivity of 83,6 % (Cl = 72,9-90,6 %) and 82,1 % (Cl = 71,3-89,4 %). The specificity of the diagnostic test was 88,7 % (Cl = 77,4-94,7 %) and 79,2 % (Cl = 66,5-88,0 %). The home care nurses achieved a test sensitivity of 79,1 % (Cl = 67,9-87,1 %), 80,6 % (Cl = 69,6-88,3 %) and 77,6 % (Cl = 66,3-85,9 %). The specificities of the diagnostic test carried out by the home care nurses were also high: 86,8 % (Cl = 75,2-93,5 %), 84,9 % (Cl = 72,9-92,1 %) in 83,0 % (Cl = 70,8- 90,8 %). We diagnosed 7 cases of AF from a group of 60 patients with the screening test by using the portable ECG monitor (an incidency of 12 %). Conclusion. The analysis of data shows, that the portable ECG monitor is an effective tool for atrial fibrillation screening on the field