Search strategy and evidence selection

Search strategy and evidence selection

Search strategy

The search strategy was designed to identify evidence on the clinical and cost effectiveness of the AliveCor Heart Monitor and AliveECG app.

The strategy was devised using a combination of subject indexing terms and free text search terms in the title, abstract and keyword heading word fields. The search terms were identified through discussion within the research team, scanning background literature, browsing database thesauri and use of the PubMed PubReMiner tool. The strategy reflected the nature of the MIB assessments as rapid evidence reviews.

The search comprised two concepts:

1) ECG

2) mobile phone / mobile tablet device / mobile application.

The mobile phone / mobile tablet / mobile application terms included terms for the named devices and operating systems that are currently indicated as supporting use of the AliveCor Heart Monitor (lines 20–22 in the MEDLINE strategy). Eight additional search lines (search lines 31–38 in the MEDLINE strategy) included terms for brand and manufacturer names (AliveCor, AliveECG), pre‑combined terms (iECG), known study names (iTransmit, search‑AF, GP‑search), terms for mobile ECGs, and highly focused title‑only searches on mobile devices and rhythms. These additional lines were used as stand‑alone searches and were designed to capture any records that may have been missed by the two concept approach.

The strategy excluded non‑English language publications. Animal studies were also excluded using a standard algorithm. No additional filters for study design were applied. Results were limited to studies published from 2008. This date reflected the year in which development of the device first began (AliveCor 2012).

The final MEDLINE strategy was peer‑reviewed by an independent information specialist. The MEDLINE strategy was translated appropriately for the other databases searched. The PubMed search was limited to records that were not fully indexed on MEDLINE. Conference‑related records were excluded from the Embase search.

The following databases were searched:

  • Cochrane Central Register of Controlled Trials (Cochrane Library, Wiley)

  • Cochrane Database of Systematic Reviews (Cochrane Library, Wiley)

  • Database of Abstracts of Reviews of Effects (Cochrane Library, Wiley)

  • Embase (Ovid SP)

  • Health Technology Assessment Database (Cochrane Library, Wiley)

  • MEDLINE and MEDLINE in Process (Ovid SP)

  • NHS Economic Evaluation Database (Cochrane Library, Wiley)

  • PubMed.

Evidence selection

A total of 1033 records were retrieved from the literature search. After de‑duplication, 642 records remained. The title and abstracts of all 642 records were screened independently by 2 reviewers, in order to exclude any that did not meet the exclusion criteria adopted for the review. The following exclusion criteria were used:

  • conference abstracts

  • non‑English language studies

  • review protocols

  • sample sizes of fewer than 10 patients (for example case reports)

  • articles of poor relevance against the search terms

  • studies undertaken before 2008

  • paediatric studies.

Disagreements between the 2 reviewers were resolved through discussion. This first sift excluded 627 papers. Full records were retrieved for the remaining 15 papers, and a second sift was carried out by the same reviewers, against the following inclusion criteria:

  • use of the AliveCor Heart Monitor

  • patients with suspected atrial fibrillation

  • comparative studies.

Papers that failed these inclusion criteria, or the previous exclusion criteria, were excluded. Again, disagreements between the 2 reviewers were resolved through discussion. Eleven papers were excluded for not assessing the AliveCor Heart Monitor (n=6), testing too few individuals (n=3) and not reporting appropriate outcomes (n=2).

All papers were assessed for methodological quality using the checklists provided within the NICE guidelines manual: appendices B–I.