Wong KC, Klimis H, Lowres N, et al. - As the use of handheld ECG devices is increasing for atrial fibrillation (AF) screening, researchers sought to evaluate their accuracy in community and hospital settings and determine how it differs among settings and other factors. Studies from community or hospital settings inscribing the diagnostic accuracy of handheld ECG devices (ie, devices producing a rhythm strip), vs a gold standard 12-lead ECG or Holter monitor, in detecting AF in adults were systematically reviewed. Among 858 identified articles, 14 were included in this study. They performed recruitment of six studies from community (n = 6,064 ECGs) and eight studies from hospital (n = 2116 ECGs) settings. They identified the pooled sensitivity of 89% and 92% and pooled specificity of 99% and 95% in the community and hospital settings, respectively. Variation in accuracy of ECG devices was observed: sensitivity ranged from 54.5% to 100% and specificity ranged from 61.9% to 100%. Meta-regression indicated significant contribution of setting and ECG device type to variations in sensitivity and specificity. Findings thereby emphasize carefully reviewing the setting including user training and handheld ECG device type.