Accuracy of Smartphone Camera Apps for Detecting AF

Apr 09, 2020
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Authors:
O’Sullivan JW, Grigg S, Crawford W, et al.
Citation:
Accuracy of Smartphone Camera Applications for Detecting Atrial Fibrillation: A Systematic Review and Meta-Analysis. JAMA Netw Open 2020;3:e202064.
Summary By:
Thomas C. Crawford, MD, FACC

Study Questions:

What is the accuracy of smartphone camera applications (apps) that diagnose atrial fibrillation (AF)?

Methods:

The authors searched MEDLINE and Embase for studies that assessed the accuracy of any smartphone apps that use the smartphone’s camera to measure the amplitude and frequency of the user’s fingertip pulse to diagnose AF.

Results:

The analysis included 10 studies, with 3,852 participants and four apps. The apps analyzed the pulse wave signal for a mean (range) of 2 (1-5) minutes. The meta-analyzed sensitivity and specificity for all apps combined were 94.2% and 95.8%, respectively. The positive predictive value (PPV) for smartphone camera apps detecting AF in an asymptomatic population aged ≥65 years was between 19.3% and 37.5%, and the negative predictive value (NPV) was between 99.8% and 99.9%. The PPV and NPV increased for individuals aged ≥65 years with hypertension (PPV, 20.5%-39.2%; NPV, 99.8%-99.9%).

Conclusions:

All smartphone camera apps had high sensitivity and specificity. While the NPV was high, the PPV was relatively low. Use of these apps in an asymptomatic population may give more false-positive than true-positive results.

Perspective:

While smartphone camera apps are great at excluding AF when it is absent, a positive result is more likely a false-positive among healthy individuals, even those aged ≥65 years with hypertension. It is possible that the PPV would improve in a selective high-risk population. Future research should address the accuracy of these apps when screening other high-risk population groups, their ability to help monitor chronic AF, and, ultimately, their associations with patient-important outcomes.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Geriatric Cardiology, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Geriatrics, Hypertension, Mobile Applications, Monitoring, Physiologic, Outcome Assessment, Health Care, Secondary Prevention, Sensitivity and Specificity


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