Validity of MENARI plus (self‐pulse assessment and clinical scoring) mobile apps for detecting atrial fibrillation in high‐risk population

• Published in: Journal of arrhythmia Vol. 39; no. 4; pp. 507 - 514
• Main Authors: Fadlan, Muhamad R., Rizal, Ardian, Satrijo, Budi, Astiawati, Tri, Rohman, Mohammad S., Baskoro, Shalahuddin S.
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.08.2023; John Wiley and Sons Inc; Wiley
• Subjects: Accuracy; Asymptomatic; Atrial fibrillation; Blood pressure; Cardiac arrhythmia; Cardiology; Diabetes; Electrocardiogram; Electrocardiography; Hypertension; Intermittent claudication; Ischemia; Mobile applications; Original; pulse palpation; scoring system; Smartphones; Stroke; Indonesia; atrial fibrillation; pulse palpation; scoring system
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.12863

Background Even before it is clinically diagnosed, atrial fibrillation (AF) can cause a stroke. This study validates self‐pulse assessment and clinical scoring (MENARI Plus) based on android apps. Objective The aim of this study was to examine the validity of AF screening using MENARI Plus compared with an ECG recording. Methods We collected a total of 1385 subjects from high‐risk population according to CHA2DS2‐VASc score ≥2, attending 8 primary care centers (PCCs) in Malang between July 2021 and December 2021. Every participant underwent self‐pulse assessment, and then was evaluated for MENARI Plus Score on android Apps. These cases had been classified as low or high probability for AF (cut‐off score 7). After that, electrocardiography examinations were performed and classified with AF and Sinus Rhythm group. Results In this study, the mean age of these patients was 61.5 ± 6.9 years old. We found that 156/1385 (11%) patients had AF. There were 68/156 (43.5%) new cases of AF. The sensitivity for self‐pulse palpation was 73.1% (95% CI: 68%–76%) and specificity was 68.3% (95% CI: 65%–72%). MENARI Plus had an area under the receiver operating curve (AUC) of 0.86 (95% CI: 0.82–0.89) with sensitivity per measurement occasion was (84%, 95% CI: 82%–88%) and specificity was (87.9%, 95% CI: 82%–90%). Conclusion In this study, we found that MENARI Plus has high sensitivity and specificity for AF. It is therefore useful for ruling out AF. It may also be a useful screen that can be applied opportunistically for previously undetected AFs. MENARI (National program of self‐pulses assesment) has low accuracy for detecting AF. We developed self‐pulse assessment and clinical scoring (MENARI Plus) based on android apps for increasing their accuracy. MENARI Plus had an area under the receiver operating curve (AUC) of 0.86 (95% CI: 0.82–0.89) with sensitivity per measurement occasion was (84%, 95% CI: 82%–88%) and specificity was (87.9%, 95% CI: 82%–90%). The positive predictive value for MENARI Plus was (46.8%, 95% CI: 42%–54%) and the negative Predictive value was (97.7%, 95% CI: 94%–98%) for detecting AF.