Smart Phone Application (MENARI Plus) For Detecting Atrial Fibrillation In General Population

Muhamad Rizki Fadlan1,2, Ardian Rizal1,2 M Saifur Rohman1,2, Monika Sitio 1,2 Diah Ivanasari1,2,Astrid
Pramudya 1,2, Ardani Galih Prakosa1,2, Liemena Harold Adrian1,2 , Dea Arie Kurniawan1,2
1
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University-dr.Saiful
Anwar General Hospital, Malang East Java, Indonesia
2
Brawijaya Cardiovascular Research Center, Brawijaya University

Background
Atrial fibrillation (AF) may cause stroke before it is clinically diagnosed. Early diagnosis is likely to
improve therapy and prognosis. Our previous study showed that MENARI (National program of Self Pulses
Assesment) has low sensitivity and specificity for detecting atrial fibrillation. We developed smartphone
application for increasing their sensitivity and specificity.

Objective
To examine accuracy of smart phone application (MENARI Plus) to detect atrial fibrillation in general
population

Methods
A total of 476 subject’s (≥50 Yo) were collected from high risk patient’s in Saiful Anwar General Hospital,
Banyuwangi and Batu, East Java, Indonesia. After brief information by Resident of cardiology and vascular
medicine, all participants were individually interviewed with a structured questionnaire for collecting
baseline characteristic, clinical sign, Mini-Mental State Examination (MMSE) score to detect cognitive
function and Profile of Mood States-Fatigue (POMS-F) to detect Fatigue. Each participant underwent 2
methods of screening: a 60-second radial pulse-check with smart phone application self checklist (MENARI
PLUS) and 12-lead electrocardiogram (AF diagnosed by cardiologist).

Results
Mean age of our subjects were 58,9±10,9 y.o. We found 25% patients with AF and 74,4% subjects were
female. The average age of the atrial fibrillation group was 60.2 ± 10.2 y.o. 16.8% had no symptoms.
Regarding the type of atrial fibrillation, A multivariate logistic regression analysis test showed that
MENARI, Hypertension, Age > 60 y.o, Palpitation, and Exercise intolerance (fatigue) were related to atrial
fibrillation (OR : 4,40, p= 0,001, OR :2,38, p=0,038, OR :2,4, p=0,049, OR :2,48, p=0,048, OR :2,43,
p=0,048, respectively). MENARI PLUS showed an area under the receiver operating curve (AUC) of 0.83
(95% CI 0.84 to 0.92) with a sensitivity of 0.84 (95% CI 0.82 to 0.94) and a specificity of 0.80 (95% CI
0.79 to 0.84) at a cut-off score of 7 on the scale.

Conclusion
The Smarphone application (MENARI PLUS) has a high sensitivity but relatively low specificity for atrial
fibrillation, thus useful for ruling out atrial fibrillation.

Keywords: atrial fibrillation, MENARI, pulse palpation