{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T19:10:58Z","timestamp":1788117058463,"version":"build-2803163510"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T00:00:00Z","timestamp":1719532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013374","name":"NIHR School for Primary Care Research","doi-asserted-by":"publisher","award":["SPCR-2014-10043"],"award-info":[{"award-number":["SPCR-2014-10043"]}],"id":[{"id":"10.13039\/501100013374","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Single-lead electrocardiograms (ECGs) can be recorded using widely available devices such as smartwatches and handheld ECG recorders. Such devices have been approved for atrial fibrillation (AF) detection. However, little evidence exists on the reliability of single-lead ECG interpretation. We aimed to assess the level of agreement on detection of AF by independent cardiologists interpreting single-lead ECGs and to identify factors influencing agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In a population-based AF screening study, adults aged \u226565 years old recorded four single-lead ECGs per day for 1\u20134 weeks using a handheld ECG recorder. Electrocardiograms showing signs of possible AF were identified by a nurse, aided by an automated algorithm. These were reviewed by two independent cardiologists who assigned participant- and ECG-level diagnoses. Inter-rater reliability of AF diagnosis was calculated using linear weighted Cohen\u2019s kappa (\u03baw). Out of 2141 participants and 162 515 ECGs, only 1843 ECGs from 185 participants were reviewed by both cardiologists. Agreement was moderate: \u03baw = 0.48 (95% confidence interval, 0.37\u20130.58) at participant level and \u03baw = 0.58 (0.53\u20130.62) at ECG level. At participant level, agreement was associated with the number of adequate-quality ECGs recorded, with higher agreement in participants who recorded at least 67 adequate-quality ECGs. At ECG level, agreement was associated with ECG quality and whether ECGs exhibited algorithm-identified possible AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Inter-rater reliability of AF diagnosis from single-lead ECGs was found to be moderate in older adults. Strategies to improve reliability might include participant and cardiologist training and designing AF detection programmes to obtain sufficient ECGs for reliable diagnoses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euae181","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T10:48:09Z","timestamp":1719226089000},"source":"Crossref","is-referenced-by-count":14,"title":["Reliability of single-lead electrocardiogram interpretation to detect atrial fibrillation: insights from the SAFER feasibility study"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7040-7881","authenticated-orcid":false,"given":"Katie","family":"Hibbitt","sequence":"first","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory , 2 Worts Causeway, Cambridge CB1 8RN , 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UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3809-2911","authenticated-orcid":false,"given":"Ben","family":"Freedman","sequence":"additional","affiliation":[{"name":"Heart Research Institute, University of Sydney , Sydney 2006 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2157-4797","authenticated-orcid":false,"given":"Simon J","family":"Griffin","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory , 2 Worts Causeway, Cambridge CB1 8RN , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7976-7172","authenticated-orcid":false,"given":"F D R ichard","family":"Hobbs","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford OX2 6GG , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah Clair","family":"Lind\u00e9n","sequence":"additional","affiliation":[{"name":"Zenicor Medical Systems AB , 113 59 Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital , Liverpool , UK"},{"name":"Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University , Aalborg , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9531-0268","authenticated-orcid":false,"given":"Jonathan","family":"Mant","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory , 2 Worts Causeway, Cambridge CB1 8RN , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3638-028X","authenticated-orcid":false,"given":"Richard J","family":"McManus","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford OX2 6GG , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhumitha","family":"Pandiaraja","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory , 2 Worts Causeway, Cambridge CB1 8RN , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6188-9363","authenticated-orcid":false,"given":"Kate","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Strangeways 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