People aged over 18 with symptoms suggestive of AF (including breathlessness, palpitations, syncope/dizziness, and chest discomfort) and/or with cardiovascular risk factors for AF (including TIA, stroke, Heart Failure, hypertension, valve disease).

Departures from this population are allowed, but the evidence will be downgraded for indirectness.

Any point of care tests used to detect AF

For example (non-exhaustive list):

• Manual pulse checking
• Pulse oximeters
• US devices
• Blood pressure monitors

  • Microlife BPM
  • Watch BP Home A
• Non-portable (but non-12 lead) ECG devices
• Portable ECG devices

  • My Diagnostick
  • AliveCor Kardia
• Smart portable devices e.g., phones, watches
• 12 lead ECG (when gold standard is long-term loop recording – see section below)

Where the same test is used with a differing number of recordings across studies, these should be regarded as separate test strategies, and should thus be dealt with separately.

Tests using differing periods of recording will also be dealt with separately. For example, pulse oximeters for 2 minutes will be in a separate category of index test to pulse oximeters used for 1 hour, and they could be compared to each other as separate index tests.

The reference standard that is used will determine the type of AF that the measured accuracy relates to. The analyses will therefore be stratified by the reference standards used, as follows:

1. 12 lead ECG, adjudicated by an expert clinician (usually cardiologist). This will theoretically pick up all constant AF but only a small proportion of intermittent AF cases. It is therefore really only useful for determining how well an index test can pick up constant AF.
2. Ambulatory monitoring for >24 hrs [any device that gives a long term recording]. These should pick up all forms of AF. It is therefore a useful way gold standard for determining how well a test can pick up any AF.

The ability of the tests to pick up AF vs no AF is being evaluated in this review, not the ability to differentiate between persistent and paroxysmal.