Feasibility and outcomes of atrial fibrillation screening using intermittent electrocardiography in a primary healthcare setting: A cross-sectional study

• Published in: PloS one 2018-05, Vol.13 (5), p.e0198069-e0198069
• Main Authors: Ghazal, Faris, Theobald, Holger, Rosenqvist, Mårten, Al-Khalili, Faris
• Format: Article
• Language: English
• Subjects: Aged; Alcohol; Analysis; Anticoagulants; Anticoagulants - therapeutic use; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Cardiac arrhythmia; Cardiology; Cross-Sectional Studies; Dementia; Diabetes; Diagnosis; Dosage and administration; Drug therapy; EKG; Electrocardiography; Electrocardiography - methods; Fasting; Feasibility Studies; Female; Fibrillation; Glucose; Health care; Health risks; Health screening; Heart; Hospitals; Humans; Ischemia; Male; Mass Screening - methods; Medical records; Medicin och hälsovetenskap; Medicine and Health Sciences; Neurosciences; Patient outcomes; Patients; Prevalence; Prevention; Primary Health Care - statistics & numerical data; Research and Analysis Methods; Risk factors; Risk groups; Screening; Stroke; Studies; Sweden - epidemiology; Therapy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0198069

Atrial fibrillation (AF) is a major risk factor for ischemic stroke unless treated with an anticoagulant. Detecting AF can be difficult because AF is often paroxysmal and asymptomatic. The aims of this study were to develop a screening model to detect AF in a primary healthcare setting and to initiate oral anticoagulant therapy in high-risk patients to prevent stroke. This was a cross-sectional study. All 70- to 74-year-old individuals registered at a single primary healthcare center in Stockholm were invited to participate in AF screening upon visiting the center during a ten-month period. Those who did not have contact with the center during this period were invited to participate by letter. Thirty-second intermittent ECG recordings were made twice a day using a handheld Zenicor device over a 2-week period in participants without AF. Oral anticoagulant therapy was offered to patients with newly detected AF. Of the 415 eligible individuals, a total of 324 (78.1%) patients participated in the study. The mean age of the participants was 72 years, 52.2% were female, and the median CHA2DS2-VASc score of the participants was 3. In the target population, 34 (8.2%) individuals had previously diagnosed AF. Among participants without previously known AF, 16 (5.5%) cases of AF were detected. The final AF prevalence in the target population was 12%. Oral anticoagulant therapy was successfully initiated in 88% of these patients with newly detected AF. The AF screening project exhibited a high participation rate and resulted in a high rate of newly discovered AF; of these newly diagnosed patients, 88% could be treated with an oral anticoagulant.