Screening for Atrial Fibrillation Using a Mobile, Single-Lead Electrocardiogram in Canadian Primary Care Clinics

• Published in: Canadian journal of cardiology 2019-07, Vol.35 (7), p.840-845
• Main Authors: Godin, Richard, Yeung, Cynthia, Baranchuk, Adrian, Guerra, Peter, Healey, Jeff S.
• Format: Article
• Language: English
• Subjects: Aged; Ambulatory Care Facilities; Atrial Fibrillation - diagnosis; Attitude of Health Personnel; Electrocardiography - instrumentation; Feasibility Studies; Humans; Mobile Applications; Ontario; Primary Health Care; Quebec; Smartphone; Surveys and Questionnaires
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2019.03.024

Atrial fibrillation (AF), which affects 1% to 4% of the general population, is an important risk factor for stroke. New technologies for AF screening are now available, but their real-world application in clinical settings has not yet been thoroughly investigated. The aim of this project was to describe the introduction and feasibility of a mobile electrocardiogram (ECG) device for AF screening in a large-scale, undifferentiated population. A total of 184 Canadian primary care physicians were provided with a KardiaMobile ECG device (AliveCor) for 3 months. Physicians were asked to obtain a single 30-second ECG recording of all patients seen in their daily practice who were ≥65 years old and not previously diagnosed with AF. Evaluation of the Kardia device by physicians was measured using a Likert scale–based questionnaire. One hundred thirty-three physicians (72%) reported their findings and completed the survey. A total of 7585 patients were screened (42% of eligible patients). AF was detected in 471 patients (6.2%). Anticoagulation therapy was initiated in 270 patients (57%). Physicians generally reported a high perceived clinical value (94%) and ease of integration (89%) of the device. Previously undiagnosed AF is common in older individuals attending primary care clinics. The KardiaMobile ECG device appears to be an effective screening tool for AF with high physician acceptability. More research on the feasibility of such novel technologies is warranted for future consideration of integration in population-based screening programs. La fibrillation auriculaire (FA), qui touche entre 1 et 4 % de la population générale, est un facteur de risque important de l’accident vasculaire cérébral. De nouvelles technologies sont aujourd’hui disponibles pour dépister la FA, mais leur mise en œuvre dans des situations réelles en milieu clinique n’a pas encore fait l’objet d’études approfondies. L’objectif de ce projet était de décrire la mise en œuvre et la faisabilité de l’utilisation d’un électrocardiographe (ECG) portable pour le dépistage de la FA dans une population importante et indifférenciée. Un moniteur ECG KardiaMobile (AliveCor) a été prêté à 184 médecins de soins primaires canadiens pendant 3 mois. Les médecins devaient réaliser un enregistrement d’ECG de 30 secondes chez tous les patients vus dans leur pratique quotidienne qui étaient âgés de 65 ans ou plus et n’avaient jamais reçu de diagnostic de FA. L’évaluation du moniteur Kardia par les médecins a é