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Zhang W, Chen Y, Hu LX, Xia JH, Ye XF, Cheng YB, Wang Y, Guo QH, Li Y, Lowres N, Freedman B, Wang JG. New-onset hypertension as a contributing factor to the incidence of atrial fibrillation in the elderly. Hypertens Res 2024; 47:1490-1499. [PMID: 38438728 DOI: 10.1038/s41440-024-01617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/20/2024] [Accepted: 01/27/2024] [Indexed: 03/06/2024]
Abstract
Hypertension and atrial fibrillation are closely related. However, hypertension is already prevalent in young adults, but atrial fibrillation usually occurs in the elderly. In the present analysis, we investigated incident atrial fibrillation in relation to new-onset hypertension in an elderly Chinese population. Our study participants were elderly (≥65 years) hypertensive residents, recruited from community health centers in the urban Shanghai (n = 4161). Previous and new-onset hypertension were defined as the use of antihypertensive medication or elevated systolic/diastolic blood pressure (≥140/90 mmHg), respectively, at entry and during follow-up on ≥ 2 consecutive clinic visits. Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. During a median of 2.1 years follow-up, the incidence rate of atrial fibrillation was 7.60 per 1000 person-years in all study participants; it was significantly higher in patients with new-onset hypertension (n = 368) than those with previous hypertension (n = 3793, 15.76 vs. 6.77 per 1000 person-years, P = 0.02). After adjustment for confounding factors, the hazard ratio for the incidence of atrial fibrillation was 2.21 (95% confidence interval 1.15-4.23, P = 0.02) in patients with new-onset hypertension versus those with previous hypertension. The association was even stronger in those aged ≥ 75 years (hazard ratio 2.70, 95% confidence interval 1.11-6.56, P = 0.03). In patients with previous hypertension, curvilinear association (P for non-linear trend = 0.04) was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension. Our study showed a significant association between new-onset hypertension and the incidence of atrial fibrillation in elderly Chinese. In an elderly Chinese population with previous and new-onset hypertension, we found that the new-onset hypertension during follow-up, compared with previous hypertension, was associated with a significantly higher risk of incident atrial fibrillation. In patients with previous hypertension, curvilinear association was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension.
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Affiliation(s)
- Wei Zhang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei-Xiao Hu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia-Hui Xia
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Fei Ye
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nicole Lowres
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Chao TF, Yeh YH, Chan YH, Lin FJ, Chen TH, Pan KL, Lin JC, Lin YJ, Chen SA. The Report of Community-Based and Government-Endorsed Screening Program of Atrial Fibrillation in Taiwan. Thromb Haemost 2024; 124:61-68. [PMID: 37434320 DOI: 10.1055/a-2127-0690] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Although international guidelines recommended opportunistic screening for atrial fibrillation (AF), the community-based AF screening program incorporated into the government-endorsed health care system is rarely reported in Asian countries. OBJECTIVES We aimed to test the feasibility of adding AF screening into the preexistent adult health check program and report the AF detection rate and percentages of OAC prescriptions before and after AF screening with the involvement of public health care systems. METHODS We performed this program in three counties (Chiayi county, Keelung City, and Yilan county) in Taiwan which have their own official preexistent adult health check programs conducted by public health bureaus for years. However, electrocardiography (ECG) was not included in these programs before. We cooperated with the public health bureaus of the three counties and performed single-lead 30-second ECG recording for every participant. RESULTS From January to December 2020, AF screening was performed in 199 sessions with 23,572 participants. AF was detected in 278 subjects with a detection rate of 1.19% (age ≥65 years: 2.39%; ≥75 years: 3.73%). The mean CHA2DS2-VASc score of these 278 subjects was 2.36, with 91% of them had a score ≥1 (males) or ≥2 (females). The number needed to screen was 42 and 27 for subjects aged ≥65 and ≥75 years, respectively. The prescription rate of OACs significantly increased from 11.4 to 60.6% in Chiayi county and from 15.8 to 50.0% in Keelung City after screening (both p-values <0.001). CONCLUSION This community-based and government-endorsed AF screening project in Taiwan demonstrated that incorporation of AF screening into the preexistent adult health check programs through co-operations with the government was feasible. Actions to detect AF, good education, and well-organized transferring plan after AF being detected with the involvement of public health care systems could result in a substantial increase in the prescription rate of OACs.
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Affiliation(s)
- Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Hsin Yeh
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsin Chan
- The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Tien-Hsing Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuo-Li Pan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Jiunn-Cherng Lin
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Cardiology, Taichung Veterans General Hospital, Chiayi branch, Chiayi, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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Romito G, Castagna P, Sabetti MC, Ablondi M, Cipone M. Evaluating the accuracy of a six-lead smartphone-based electrocardiographic device compared with standard electrocardiography in brachymorphic dogs. Vet Rec 2023; 193:e2879. [PMID: 37126211 DOI: 10.1002/vetr.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/27/2023] [Accepted: 03/09/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND No previous study has evaluated the accuracy of a six-lead smartphone-based electrocardiographic (s-ECG) device in dogs. METHODS This was a prospective multicentre study. Patients referred for cardiologic consultation were selected. In each patient, a 30-second electrocardiogram was simultaneously acquired with a novel six-lead s-ECG and a standard six-lead ECG machine (st-ECG). A board-certified cardiologist evaluated each recording. Nineteen ECG variables, including heart rate and rhythm, as well as quantitative and qualitative features of waves, segments and intervals, were analysed. Agreement between s-ECG and st-ECG was evaluated using Cohen's kappa coefficient and the Bland-Altman test. RESULTS Seventy-five dogs were enrolled, and 140 ECG tracings were analysed. There was perfect agreement between the two methodologies for heart rate and rhythm classification, both in dogs with sinus rhythm and those with pathological rhythms. Although some disagreement was found when comparing measurements of quantitative variables obtained with the s-ECG and the st-ECG, none of the differences was of clinical relevance. LIMITATIONS The sample size was limited, and the interobserver variability was not analysed. CONCLUSION The six-lead s-ECG studied herein is comparable to the st-ECG for heart rate and rhythm assessment, and seems clinically acceptable for the interpretation of waves, segments and intervals in dogs.
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Affiliation(s)
- Giovanni Romito
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Italy
| | | | | | - Michela Ablondi
- Department of Veterinary Sciences, University of Parma, Parma, Italy
| | - Mario Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Italy
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Brandes A, Stavrakis S, Freedman B, Antoniou S, Boriani G, Camm AJ, Chow CK, Ding E, Engdahl J, Gibson MM, Golovchiner G, Glotzer T, Guo Y, Healey JS, Hills MT, Johnson L, Lip GYH, Lobban T, Macfarlane PW, Marcus GM, McManus DD, Neubeck L, Orchard J, Perez MV, Schnabel RB, Smyth B, Steinhubl S, Turakhia MP. Consumer-Led Screening for Atrial Fibrillation: Frontier Review of the AF-SCREEN International Collaboration. Circulation 2022; 146:1461-1474. [PMID: 36343103 PMCID: PMC9673231 DOI: 10.1161/circulationaha.121.058911] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/22/2022] [Indexed: 11/09/2022]
Abstract
The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional-led randomized controlled studies using multiple ECG recordings or continuous ECG monitoring to detect AF have failed to demonstrate a significant reduction in stroke. Although it remains uncertain if consumer-led AF screening reduces stroke, it could increase early diagnosis of AF and facilitate an integrated approach, including appropriate anticoagulation, rate or rhythm management, and risk factor modification to reduce complications. Companies marketing AF screening devices should report the accuracy and performance of their products in high- and low-risk populations and avoid claims about clinical outcomes unless improvement is demonstrated in randomized clinical trials. Generally, the diagnostic yield of AF screening increases with the number, duration, and temporal dispersion of screening sessions, but the prognostic importance may be less than for AF detected by single-time point screening, which is largely permanent, persistent, or high-burden paroxysmal AF. Consumer-initiated ECG recordings suggesting possible AF always require confirmation by a health care professional experienced in ECG reading, whereas suspicion of AF on the basis of photoplethysmography must be confirmed with an ECG. Consumer-led AF screening is unlikely to be cost-effective for stroke prevention in the predominantly young, early adopters of this technology. Studies in older people at higher stroke risk are required to demonstrate both effectiveness and cost-effectiveness. The direct interaction between companies and consumers creates new regulatory gaps in relation to data privacy and the registration of consumer apps and devices. Although several barriers for optimal use of consumer-led screening exist, results of large, ongoing trials, powered to detect clinical outcomes, are required before health care professionals should support widespread adoption of consumer-led AF screening.
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Affiliation(s)
| | - Stavros Stavrakis
- Cardiovascular Section, University of Oklahoma Health Science Center
| | - Ben Freedman
- Heart Research Institute, University of Sydney, Sydney, Australia
| | | | - Giuseppe Boriani
- Department of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Clara K. Chow
- Cardiovascular Division, University of Sydney, Sydney, Australia
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Johan Engdahl
- Department of Cardiology, Karolinska Institute, Stockholm, Sweeden
| | - Michael M. Gibson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Taya Glotzer
- Hackensack University Medical Center, Hackensack, NJ
| | - Yutao Guo
- Chinese PLA General Hospital, Beijing, China
| | | | | | | | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | | | | | - Gregory M. Marcus
- Department of Cardiology, University of California, San Francisco, San Franscisco, CA
| | - David D. McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Lis Neubeck
- Centre for Cardiovascular Health, Edinburgh Napier University
| | - Jessica Orchard
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | | | | | - Breda Smyth
- Department of Public Health, Health Service Executive West, Galway, Ireland
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5
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Svennberg E, Tjong F, Goette A, Akoum N, Di Biase L, Bordachar P, Boriani G, Burri H, Conte G, Deharo JC, Deneke T, Drossart I, Duncker D, Han JK, Heidbuchel H, Jais P, de Oliviera Figueiredo MJ, Linz D, Lip GYH, Malaczynska-Rajpold K, Márquez M, Ploem C, Soejima K, Stiles MK, Wierda E, Vernooy K, Leclercq C, Meyer C, Pisani C, Pak HN, Gupta D, Pürerfellner H, Crijns HJGM, Chavez EA, Willems S, Waldmann V, Dekker L, Wan E, Kavoor P, Turagam MK, Sinner M. How to use digital devices to detect and manage arrhythmias: an EHRA practical guide. Europace 2022; 24:979-1005. [PMID: 35368065 DOI: 10.1093/europace/euac038] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Emma Svennberg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Fleur Tjong
- Heart Center, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Andreas Goette
- St. Vincenz Hospital Paderborn, Paderborn, Germany
- MAESTRIA Consortium/AFNET, Münster, Germany
| | - Nazem Akoum
- Heart Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Haran Burri
- Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Giulio Conte
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Jean Claude Deharo
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France
- Aix Marseille Université, C2VN, Marseille, France
| | - Thomas Deneke
- Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Inga Drossart
- European Society of Cardiology, Sophia Antipolis, France
- ESC Patient Forum, Sophia Antipolis, France
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Janet K Han
- Cardiac Arrhythmia Centers, Veterans Affairs Greater Los Angeles Healthcare System and University of California, Los Angeles, CA, USA
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Cardiovascular Research Group, Antwerp University, Antwerp, Belgium
| | - Pierre Jais
- Bordeaux University Hospital, Bordeaux, France
| | | | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Manlio Márquez
- Department of Electrocardiology, Instituto Nacional de Cardiología, Mexico City, Mexico
| | - Corrette Ploem
- Department of Ethics, Law and Medical Humanities, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Kyoko Soejima
- Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Eric Wierda
- Department of Cardiology, Dijklander Hospital, Hoorn, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Cristiano Pisani
- Arrhythmia Unit, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Hui Nam Pak
- Yonsei University, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Dhiraj Gupta
- Faculty of Health and Life Sciences, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK
| | | | - H J G M Crijns
- Em. Professor of Cardiology, University of Maastricht, Maastricht, Netherlands
| | - Edgar Antezana Chavez
- Division of Cardiology, Hospital General de Agudos Dr. Cosme Argerich, Pi y Margall 750, C1155AHB Buenos Aires, Argentina
- Division of Cardiology, Hospital Belga, Antezana 455, C0000 Cochabamba, Bolivia
| | | | - Victor Waldmann
- Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France
- Adult Congenital Heart Disease Unit, European Georges Pompidou Hospital, Paris, France
| | - Lukas Dekker
- Catharina Ziekenhuis Eindhoven, Eindhoven, Netherlands
| | - Elaine Wan
- Cardiology and Cardiac Electrophysiology, Columbia University, New York, NY, USA
| | - Pramesh Kavoor
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Moritz Sinner
- Univ. Hospital Munich, Campus Grosshadern, Munich, Germany
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Prevalence of major electrocardiographic abnormalities in patients with hypertension in a primary care clinic in Hong Kong. BMC Cardiovasc Disord 2022; 22:225. [PMID: 35585508 PMCID: PMC9118877 DOI: 10.1186/s12872-022-02662-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Hypertension is strongly associated with cardiovascular events. Studies have shown that electrocardiographic (ECG) abnormalities were associated with increased risks for cardiovascular events. However local data is limited. The objectives of this study were: (1) to determine the prevalence of major electrocardiographic abnormalities in patients with hypertension in primary care in Hong Kong, and (2) to determine the association of major electrocardiographic abnormalities with patients’ socio-economical background, cardiovascular disease and cardiovascular risk factors.
Methods This was a cross-sectional study. Subjects were hypertensive patients aged between 18 and 80 who were enrolled in the Risk Assessment and Management Programme (RAMP) in a general outpatient clinic in Hong Kong. Outcome measures were prevalence of probable ischaemic heart disease (IHD), complete left bundle branch block (LBBB), left ventricular hypertrophy (LVH) and atrial fibrillation (AF) in patients with hypertension. The Pearson Chi-square test, independent t-test and Mantel–Haenszel test were used to measure the association between socioeconomic characteristics and cardiovascular risk factors, and ECG abnormalities.
Results 504 hypertensive patients aged 18–80 were recruited in a general outpatient clinic. 6.3% had probable IHD, 0.4% had complete LBBB, 4.0% had LVH and 1.0% had AF. Probable IHD was associated with smoking (P = 0.032), hypercholesterolaemia (P = 0.037) and higher 10-year CV risk (P = 0.04). Complete LBBB was associated with smoking (P = 0.021) and hypercholesterolaemia (P = 0.022). LVH was associated with male gender (P = 0.001) and longer duration of hypertension (P = 0.035). AF was not significantly associated with any of the clinical or sociodemographic parameters.
Conclusions This study showed that a significant proportion of patients with hypertension at the primary care setting in Hong Kong had probable ischaemic heart disease, left ventricular hypertrophy and atrial fibrillation. This finding is consistent with both overseas data and historic data in Hong Kong. The detection of electrocardiographic abnormalities is helpful in hypertension management by improving risk stratification. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02662-1.
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Bonini N, Vitolo M, Imberti JF, Proietti M, Romiti GF, Boriani G, Paaske Johnsen S, Guo Y, Lip GYH. Mobile health technology in atrial fibrillation. Expert Rev Med Devices 2022; 19:327-340. [PMID: 35451347 DOI: 10.1080/17434440.2022.2070005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Mobile health (mHealth) solutions in atrial fibrillation (AF) are becoming widespread, thanks to everyday life devices such as smartphones. Their use is validated both in monitoring and in screening scenarios. In the published literature, the diagnostic accuracy of mHealth solutions wide differs, and their current clinical use is not well established in principal guidelines. AREAS COVERED mHealth solutions have progressively built an AF-detection chain to guide patients from the device's alert signal to the health care practitioners' (HCPs) attention. This review aims to critically evaluate the latest evidence regarding mHealth devices and the future possible patient's uses in everyday life. EXPERT OPINION The patients are the first to be informed of the rhythm anomaly, leading to the urgency of increasing the patients' AF self-management. Furthermore, HCPs need to update themselves about mHealth devices use in clinical practice. Nevertheless, these are promising instruments in specific populations, such as post-stroke patients, to promote an early arrhythmia diagnosis in the post-ablation/cardioversion period, allowing checks on the efficacy of the treatment or intervention.
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Affiliation(s)
- Niccolò Bonini
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo Francesco Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Department of Translational and Precision Medicine, Sapienza-University of Rome, Rome, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Yutao Guo
- Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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8
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Lubitz SA, Atlas SJ, Ashburner JM, Trisini Lipsanopoulos AT, Borowsky LH, Guan W, Khurshid S, Ellinor PT, Chang Y, McManus DD, Singer DE. Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: VITAL-AF Randomized Controlled Trial. Circulation 2022; 145:946-954. [PMID: 35232217 PMCID: PMC8960369 DOI: 10.1161/circulationaha.121.057014] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Undiagnosed atrial fibrillation (AF) may cause preventable strokes. Guidelines differ regarding AF screening recommendations. We tested whether point-of-care screening with a handheld single-lead ECG at primary care practice visits increases diagnoses of AF. METHODS We randomized 16 primary care clinics 1:1 to AF screening using a handheld single-lead ECG (AliveCor KardiaMobile) during vital sign assessments, or usual care. Patients included were ages ≥65 years. Screening results were provided to primary care clinicians at the encounter. All confirmatory diagnostic testing and treatment decisions were made by the primary care clinician. New AF diagnoses during the 1-year follow-up were ascertained electronically and manually adjudicated. Proportions and incidence rates were calculated. Effect heterogeneity was assessed. RESULTS Of 30 715 patients without prevalent AF (n=15 393 screening [91% screened], n=15 322 control), 1.72% of individuals in the screening group had new AF diagnosed at 1 year versus 1.59% in the control group (risk difference, 0.13% [95% CI, -0.16 to 0.42]; P=0.38). In prespecified subgroup analyses, new AF diagnoses in the screening and control groups were greater among those aged ≥85 years (5.56% versus 3.76%, respectively; risk difference, 1.80% [95% CI, 0.18 to 3.30]). The difference in newly diagnosed AF between the screening period and the previous year was marginally greater in the screening versus control group (0.32% versus -0.12%; risk difference, 0.43% [95% CI, -0.01 to 0.84]). The proportion of individuals with newly diagnosed AF who were initiated on oral anticoagulants was not different in the screening (n=194, 73.5%) and control (n=172, 70.8%) arms (risk difference, 2.7% [95% CI, -5.5 to 10.4]). CONCLUSIONS Screening for AF using a single-lead ECG at primary care visits did not affect new AF diagnoses among all individuals aged 65 years or older compared with usual care. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03515057.
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Affiliation(s)
- Steven A. Lubitz
- Demoulas Center for Cardiac Arrhythmias and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steven J. Atlas
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey M. Ashburner
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Leila H. Borowsky
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Wyliena Guan
- University of North Carolina, Chapel Hill, NC, USA
| | - Shaan Khurshid
- Demoulas Center for Cardiac Arrhythmias and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patrick T. Ellinor
- Demoulas Center for Cardiac Arrhythmias and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yuchiao Chang
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David D. McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel E. Singer
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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9
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Chan N, Orchard J, Agbayani M, Boddington D, Chao T, Johar S, John B, Joung B, Krishinan S, Krittayaphong R, Kurokawa S, Lau C, Lim TW, Linh PT, Long VH, Naik A, Okumura Y, Sasano T, Yan B, Raharjo SB, Hanafy DA, Yuniadi Y, Nwe N, Awan ZA, Huang H, Freedman B. 2021 Asia Pacific Heart Rhythm Society (APHRS) practice guidance on atrial fibrillation screening. J Arrhythm 2022; 38:31-49. [PMID: 35222749 PMCID: PMC8851593 DOI: 10.1002/joa3.12669] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 12/19/2022] Open
Abstract
In this paper, the Asia Pacific Heart Rhythm Society (APHRS) sought to provide practice guidance on AF screening based on recent evidence, with specific considerations relevant to the Asia-Pacific region. A key recommendation is opportunistic screening for people aged ≥65 years (all countries), with systematic screening to be considered for people aged ≥75 years or who have additional risk factors (all countries).
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Affiliation(s)
- Ngai‐Yin Chan
- Princess Margaret HospitalHong Kong Special Administrative RegionChina
| | - Jessica Orchard
- Agnes Ginges Centre for Molecular CardiologyCentenary InstituteSydneyAustralia
- Charles Perkins CentreThe University of SydneySydneyAustralia
| | - Michael‐Joseph Agbayani
- Division of ElectrophysiologyPhilippine Heart CenterManilaPhilippines
- Division of Cardiovascular MedicinePhilippine General HospitalManilaPhilippines
| | | | - Tze‐Fan Chao
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Institute of Clinical Medicine, and Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Sofian Johar
- Consultant CardiologistHead of CardiologyRIPAS HospitalBandar Seri BegawanBrunei Darussalam
- Consultant Cardiac ElectrophysiologistHead of Cardiac ElectrophysiologyGleneagles JPMCJerudongBrunei Darussalam
- Institute of Health SciencesUniversiti Brunei DarussalamJalan Tungku Link GadongBrunei Darussalam
| | - Bobby John
- Cardiology UnitTownsville University HospitalTownsvilleAustralia
- James Cook UniversityTownsvilleAustralia
| | - Boyoung Joung
- Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | | | - Rungroj Krittayaphong
- Division of CardiologyDepartment of MedicineSiriraj HospitalMahidol UniversityBangkokThailand
| | - Sayaka Kurokawa
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Chu‐Pak Lau
- Department of MedicineQueen Mary HospitalThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Toon Wei Lim
- National University HospitalNational University Heart CentreSingapore
| | | | | | - Ajay Naik
- Division of CardiologyCare Institute of Medical Sciences HospitalAhmedabadIndia
| | - Yasuo Okumura
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Bernard Yan
- Melbourne Brain CentreUniversity of MelbourneMelbourneAustralia
| | - Sunu Budhi Raharjo
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Indonesia, and National Cardiovascular Center Harapan KitaJakartaIndonesia
| | - Dicky Armein Hanafy
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Indonesia, and National Cardiovascular Center Harapan KitaJakartaIndonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Indonesia, and National Cardiovascular Center Harapan KitaJakartaIndonesia
| | - Nwe Nwe
- Department of CardiologyYangon General HospitalUniversity of MedicineYangonMyanmar
| | | | - He Huang
- Wuhan University Renmin HospitalWuhanChina
| | - Ben Freedman
- Charles Perkins CentreThe University of SydneySydneyAustralia
- Heart Research InstituteCharles Perkins CentreUniversity of SydneySydneyAustralia
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10
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Cabrera JD, Fluxà G, Fuentes C, Hoyo J, Navarro M, Sant E, de la Poza MA, Altés A, Duch N, Caubet M, Vieytes G, Pérez AM, Herrero MA, Gracia P, Domínguez V, Mont L, Coll-Vinent B. A programme for early diagnosis of atrial fibrillation: a multi-centre study in primary care. Fam Pract 2022; 39:99-105. [PMID: 34160603 DOI: 10.1093/fampra/cmab057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a morbid disease whose complications can be prevented if prompt and correctly treated. OBJECTIVE To assess the usefulness of an early AF diagnosis programme in at-risk individuals in primary care centres. METHODS In an open-label, multi-centre, controlled interventional study, individuals with one or more risk factors for AF but without known AF were enrolled. They were allocated to intervention and control groups in a 1:2 ratio. Participants in the intervention group had three clinical and educational visits (0, 6 and 12 months). In intervention subgroup A, an electrocardiogram (ECG) was performed at each visit and in subgroup B, only if arrhythmia was detected on auscultation. After 2 years, the medical records of all participants were reviewed. Participants diagnosed with AF were followed for two additional years. RESULTS Of the total 2231 participants enrolled, 1503 (67.36%) were allocated to the control group and 728 (32.63%) to the intervention groups (355 in subgroup A, 373 subgroup B). The groups showed similar clinical characteristics. New-onset AF was diagnosed in 38 patients. Early detection in subgroup B was similar to subgroup A and superior to control group (3.2% versus 1.2%, hazard ratio 3.149, 95% confidence interval 1.503-6.597, P = 0.002). AF patients in subgroups A and B had similar long-term complications and a tendency for fewer complications than AF patients in the control group. CONCLUSIONS An intervention programme consisting of health education, systematic auscultation and opportunistic ECG by a primary care provider is a useful method for the early diagnosis of AF.
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Affiliation(s)
- Javier D Cabrera
- Atrial Fibrillation Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Guillem Fluxà
- Primary Care Centre Poble Sec-Manso, Barcelona, Spain
| | | | - Jordi Hoyo
- Primary Care Centre Numancia, Barcelona, Spain
| | - Marta Navarro
- Primary Care Centre Borrell, CAPSE, Barcelona, Spain
| | - Elisenda Sant
- Primary Care Centre Casanova, CAPSE, Barcelona, Spain
| | | | | | - Núria Duch
- Primary Care Centre Poble Sec-Manso, Barcelona, Spain
| | | | | | - Ana M Pérez
- Primary Care Centre Montornès-Montmeló, Barcelona, Spain
| | | | - Pablo Gracia
- Primary Care Centre Borrell, CAPSE, Barcelona, Spain
| | | | - Lluís Mont
- Atrial Fibrillation Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Blanca Coll-Vinent
- Atrial Fibrillation Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Grup de Recerca 'Urgències: processos i patologies', IDIBAPS, Barcelona, Spain
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11
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Remote Screening for Atrial Fibrillation by a Federal Cardiac Monitoring System in Primary Care Patients in Russia: Results from the Prospective Interventional Multicenter FECAS-AFS Study. Glob Heart 2022; 17:4. [PMID: 35174045 PMCID: PMC8782096 DOI: 10.5334/gh.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Objective: Methods: Results: Conclusion:
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12
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Zwartkruis VW, Geelhoed B, Suthahar N, Bakker SJL, Gansevoort RT, van Gelder IC, de Boer RA, Rienstra M. Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study. Open Heart 2022; 8:openhrt-2021-001786. [PMID: 34969833 PMCID: PMC8718469 DOI: 10.1136/openhrt-2021-001786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022] Open
Abstract
AIMS It is unknown whether screen-detected atrial fibrillation (AF) carries cardiovascular risks similar to clinically detected AF. We aimed to compare clinical outcomes between individuals with screen-detected and clinically detected incident AF. METHODS We studied 8265 participants (age 49 ± 13 years, 50% women) without prevalent AF from the community-based Prevention of Renal and Vascular End-stage Disease (PREVEND) study. By design of the PREVEND study, 70% of participants had a urinary albumin concentration >10 mg/L. Participants underwent 12-lead ECG screening at baseline and every 3 years. AF was considered screen-detected when first diagnosed during a study visit and clinically detected when first diagnosed during a hospital visit. We analysed data from the baseline visit (1997-1998) up to the third follow-up visit (2008). We used Cox regression with screen-detected and clinically detected AF as time-varying covariates to study the association of screen-detected and clinically detected AF with all-cause mortality, incident heart failure (HF) and vascular events. RESULTS During a follow-up of 9.8 ± 2.3 years, 265 participants (3.2%) developed incident AF, of whom 60 (23%) had screen-detected AF. The majority of baseline characteristics were comparable between individuals with screen-detected and clinically detected AF. Unadjusted, both screen-detected and clinically detected AF were strongly associated with mortality, incident HF, and vascular events. After multivariable adjustment, screen-detected and clinically detected AF remained significantly associated with mortality (HR 2.21 (95% CI 1.09 to 4.47) vs 2.95 (2.18 to 4.00), p for difference=0.447) and incident HF (4.90 (2.28 to 10.57) vs 3.98 (2.49 to 6.34), p for difference=0.635). After adjustment, screen-detected AF was not significantly associated with vascular events, whereas clinically detected AF was (1.12 (0.46 to 2.71) vs 1.92 (1.21 to 3.06), p for difference=0.283). CONCLUSION Screen-detected incident AF was associated with an increased risk of adverse outcomes, especially all-cause mortality and incident HF. The risk of outcomes was not significantly different between screen-detected AF and clinically detected AF.
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Affiliation(s)
- Victor W Zwartkruis
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bastiaan Geelhoed
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Navin Suthahar
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Nephrology Division, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, Nephrology Division, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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13
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Canty E, MacGilchrist C, Tawfick W, McIntosh C. Screening for Atrial Fibrillation in Community and Primary CareSettings: A Scoping Review. J Atr Fibrillation 2021; 13:2452. [PMID: 34950333 DOI: 10.4022/jafib.2452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/16/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022]
Abstract
Background Atrial Fibrillation (AF) is the most common tachyarrhythmia and is associated with increased risk of stroke, morbidity and mortality. AF is responsible for up to a quarter of all strokes and is often asymptomatic until a stroke occurs.Screening for AF is a valuable approach to reduce the burden of stroke in the population. Objectives The motivation for this review was to synthesise and appraise the evidence for screening for AF in the community. The aims of this scoping review are 1). To describe the prevalence of newly diagnosed AF in screening programmes 2). Identify which techniques/ tools are employed for AF screening 3). To describe the setting and personnel involved in screening for AF. Eligibility Criteria All forms of AF screening in adults (≥18 years) in primary and community care settings. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR). Results Fifty-nine papers were included; most were cross-sectional studies (n=41) and RCTs (n=7). Prevalence of AF ranged from 0-34.5%. Screening tools and techniquesincluded the 12-lead ECG (n=33), the 1-lead ECG smartphone based Alivecor® (n=14) and pulse palpation (n=12). Studies were undertaken in community settings (n=30) or in urban/rural primary care (n=28). Personnel collecting research data were in the main members of the research team (n=31), GPs (n=16), practice nurses (n=10), participants (n=8) and pharmacists (n=4). Conclusion Prevalence of AF increased with advancing age. AF screening should target individuals at greatest risk of the condition including older adults≥65 years of age. Emerging novel technologies may increase the accessibility of AF screening in community and home settings. There is a need for high quality research to investigate AF prevalence and establish accuracy and validity for traditional versus novel screening tools used to screen for AF.
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Affiliation(s)
- Emma Canty
- Discipline of Podiatric Medicine, School of Health Sciences, NUI Galway
| | - Claire MacGilchrist
- Discipline of Podiatric Medicine, School of Health Sciences, NUI Galway.,Alliance for Research and Innovation in Wounds, NUI Galway
| | - Wael Tawfick
- Alliance for Research and Innovation in Wounds, NUI Galway.,Vascular Department, University Hospital Galway, Saolta University Health Care Group.,School of Medicine, NUI Galway
| | - Caroline McIntosh
- Discipline of Podiatric Medicine, School of Health Sciences, NUI Galway.,Alliance for Research and Innovation in Wounds, NUI Galway
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14
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Ko JS, Jeong HK. Screening for Atrial Fibrillation Using a Single Lead ECG Monitoring Device. Chonnam Med J 2021; 57:191-196. [PMID: 34621639 PMCID: PMC8485083 DOI: 10.4068/cmj.2021.57.3.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia which needs management for stroke prevention. Therefore, it has emphasized the importance of screening for general population to detect AF earlier. We conducted screening for AF in the Chonbuk region in South Korea. Participants who were older than 50 years were enrolled. The screening test used a single lead electrocardiography (ECG) (KardiaBand, AliveCor, CA, USA). Diagnosis of AF was confirmed by electrophysiologists, if the single lead ECG demonstrated AF of more than 30 seconds. We analyzed the prevalence of AF and the characteristics of newly detected AF patients. A total of 2728 participants, 145 (5.3%) participants had already been diagnosed with AF before. The number of screening positive was 55. Among them, 40 participants were confirmed for AF. Male gender and age older than 70 years were the independent risk factors for AF among the screening positive participants. Most of newly detected AF patients were at high risk for stroke which had more than 2 points on the CHA2DS2-VASc score. We followed up with those patients and encouraged them to visit the hospital. As a result, 31 (77.5%) patients started to manage AF. The additional 1.2% of AF was detected by a screening test with a single lead ECG monitor device. Considering most participants of newly detected AF by screening were at high risk for stroke, it was thought that AF was still undertreated. Therefore, screening tests with simple mobile device might be useful for early detection of AF.
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Affiliation(s)
- Jum Suk Ko
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Hyung Ki Jeong
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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15
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Koh KT, Law WC, Zaw WM, Foo DHP, Tan CT, Steven A, Samuel D, Fam TL, Chai CH, Wong ZS, Xaviar S, Bhavnani CD, Tan JSH, Oon YY, Said A, Fong AYY, Ong TK. Smartphone electrocardiogram for detecting atrial fibrillation after a cerebral ischaemic event: a multicentre randomized controlled trial. Europace 2021; 23:1016-1023. [PMID: 33782701 DOI: 10.1093/europace/euab036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is a preventable cause of ischaemic stroke but it is often undiagnosed and undertreated. The utility of smartphone electrocardiogram (ECG) for the detection of AF after ischaemic stroke is unknown. The aim of this study is to determine the diagnostic yield of 30-day smartphone ECG recording compared with 24-h Holter monitoring for detecting AF ≥30 s. METHODS AND RESULTS In this multicentre, open-label study, we randomly assigned 203 participants to undergo one additional 24-h Holter monitoring (control group, n = 98) vs. 30-day smartphone ECG monitoring (intervention group, n = 105) using KardiaMobile (AliveCor®, Mountain View, CA, USA). Major inclusion criteria included age ≥55 years old, without known AF, and ischaemic stroke or transient ischaemic attack (TIA) within the preceding 12 months. Baseline characteristics were similar between the two groups. The index event was ischaemic stroke in 88.5% in the intervention group and 88.8% in the control group (P = 0.852). AF lasting ≥30 s was detected in 10 of 105 patients in the intervention group and 2 of 98 patients in the control group (9.5% vs. 2.0%; absolute difference 7.5%; P = 0.024). The number needed to screen to detect one AF was 13. After the 30-day smartphone monitoring, there was a significantly higher proportion of patients on oral anticoagulation therapy at 3 months compared with baseline in the intervention group (9.5% vs. 0%, P = 0.002). CONCLUSIONS Among patients ≥55 years of age with a recent cryptogenic stroke or TIA, 30-day smartphone ECG recording significantly improved the detection of AF when compared with the standard repeat 24-h Holter monitoring.
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Affiliation(s)
- Keng Tat Koh
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Wan Chung Law
- Department of Medicine, Neurology Unit, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Win Moe Zaw
- Department of Medicine, Neurology Unit, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Diana Hui Ping Foo
- Clinical Research Centre, Institute for Clinical Research, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Chen Ting Tan
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Anderson Steven
- Department of Medicine, Neurology Unit, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Desmond Samuel
- Department of Medicine, Miri Hospital, Jalan Cahaya, 98000 Miri, Sarawak, Malaysia
| | - Tem Lom Fam
- Department of Medicine, Miri Hospital, Jalan Cahaya, 98000 Miri, Sarawak, Malaysia
| | - Ching Hua Chai
- Department of Medicine, Miri Hospital, Jalan Cahaya, 98000 Miri, Sarawak, Malaysia
| | - Zhai Sing Wong
- Department of Medicine, Miri Hospital, Jalan Cahaya, 98000 Miri, Sarawak, Malaysia
| | - Sivaraj Xaviar
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Chandan Deepak Bhavnani
- Department of Medicine, Bintulu Hospital, Jalan Bukit Nyabau, 97000 Bintulu, Sarawak, Malaysia
| | - Jason Seng Hong Tan
- Department of Medicine, Bintulu Hospital, Jalan Bukit Nyabau, 97000 Bintulu, Sarawak, Malaysia
| | - Yen Yee Oon
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Asri Said
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia.,Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia
| | - Alan Yean Yip Fong
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia.,Clinical Research Centre, Institute for Clinical Research, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Centre, 3rd Roundabout, Samarahan Expressway, 94300 Kota Samarahan, Sarawak, Malaysia
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16
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Beerten SG, Proesmans T, Vaes B. The effect of a case-finding app on the detection rate of atrial fibrillation compared with opportunistic screening in primary care patients: protocol for a cluster randomized trial. Trials 2021; 22:525. [PMID: 34372905 PMCID: PMC8351454 DOI: 10.1186/s13063-021-05497-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Atrial fibrillation is a cardiac arrhythmia commonly encountered in a primary care setting. Current screening is limited to pulse palpation and ECG confirmation when an irregular pulse is found. Paroxysmal atrial fibrillation will, however, still be difficult to pick up. With the advent of smartphones, screening could be more cost-efficient by making use of simple applications, lowering the need for intensive screening to discover (paroxysmal) atrial fibrillation. Methods/design This cluster randomized trial will examine the effect of using a smartphone-based application such as FibriCheck® on the detection rate of atrial fibrillation in a Flemish general practice population. This study will be conducted in 22 primary care practices across the Flanders region of Belgium and will last 12 months. Patients above 65 years of age will be divided in control and intervention groups on the practice level. The control group will be subjected to standard opportunistic screening only, while the intervention group will be prescribed the FibriCheck® app on top of this opportunistic screening. The difference in detection rate between control and intervention groups will be calculated at the end of the study. We will use the online platform INTEGO for pseudonymized data collection and analysis, and risk calculation. Discussion Smartphone applications might offer a way to cost-effectively screen for (paroxysmal) atrial fibrillation in a primary care setting. This could open the door for the update of future screening guidelines. Trial registration ClinicalTrials.gov NCT04545723. Registered on September 10, 2020.
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Affiliation(s)
| | | | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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17
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Quarterly versus annual ECG screening for atrial fibrillation in older Chinese individuals (AF-CATCH): a prospective, randomised controlled trial. THE LANCET HEALTHY LONGEVITY 2021; 2:e470-e478. [DOI: 10.1016/s2666-7568(21)00138-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022]
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18
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Lopez Perales CR, Van Spall HGC, Maeda S, Jimenez A, Laţcu DG, Milman A, Kirakoya-Samadoulougou F, Mamas MA, Muser D, Casado Arroyo R. Mobile health applications for the detection of atrial fibrillation: a systematic review. Europace 2021; 23:11-28. [PMID: 33043358 DOI: 10.1093/europace/euaa139] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Indexed: 12/21/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart failure. We aimed to conduct a systematic review of the literature and summarize the performance of mobile health (mHealth) devices in diagnosing and screening for AF. METHODS AND RESULTS We conducted a systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Forty-three studies met the inclusion criteria and were divided into two groups: 28 studies aimed at validating smart devices for AF diagnosis, and 15 studies used smart devices to screen for AF. Evaluated technologies included smartphones, with photoplethysmographic (PPG) pulse waveform measurement or accelerometer sensors, smartbands, external electrodes that can provide a smartphone single-lead electrocardiogram (iECG), such as AliveCor, Zenicor and MyDiagnostick, and earlobe monitor. The accuracy of these devices depended on the technology and the population, AliveCor and smartphone PPG sensors being the most frequent systems analysed. The iECG provided by AliveCor demonstrated a sensitivity and specificity between 66.7% and 98.5% and 99.4% and 99.0%, respectively. The PPG sensors detected AF with a sensitivity of 85.0-100% and a specificity of 93.5-99.0%. The incidence of newly diagnosed arrhythmia ranged from 0.12% in a healthy population to 8% among hospitalized patients. CONCLUSION Although the evidence for clinical effectiveness is limited, these devices may be useful in detecting AF. While mHealth is growing in popularity, its clinical, economic, and policy implications merit further investigation. More head-to-head comparisons between mHealth and medical devices are needed to establish their comparative effectiveness.
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Affiliation(s)
- Carlos Ruben Lopez Perales
- Department of Cardiology, Hopital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.,Servicio de Cardiología, Hospital Universitario Miguel Servet, Isabel La Catolica 1-3, Zaragoza 50009, Spain
| | - Harriette G C Van Spall
- Division of Cardiology, Department of Medicine, Population Health Research Institute, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, Canada
| | - Shingo Maeda
- Advanced Arrhythmia Research, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Alejandro Jimenez
- Division of Cardiology, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA
| | - Decebal Gabriel Laţcu
- Department of Cardiology, Centre Hospitalier Princesse Grace, Avenue Pasteur, 98000, Monaco, Monaco (Principalty)
| | - Anat Milman
- Department of Cardiology, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université librede Bruxelles, Avenue Franklin Roosevelt 50 - 1050, Brussels, Belgium
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, Keele, Newcastle ST5 5BG, UK.,Royal Stoke University Hospital, Newcastle Rd, Stoke-on-Trent ST4 6QG, UK
| | - Daniele Muser
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Ruben Casado Arroyo
- Department of Cardiology, Hopital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
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Freedman B, Hindricks G, Banerjee A, Baranchuk A, Ching CK, Du X, Fitzsimons D, Healey JS, Ikeda T, Lobban TCA, Mbakwem A, Narasimhan C, Neubeck L, Noseworthy P, Philbin DM, Pinto FJ, Rwebembera J, Schnabel RB, Svendsen JH, Aguinaga L, Arbelo E, Böhm M, Farhan HA, Hobbs FDR, Martínez-Rubio A, Militello C, Naik N, Noubiap JJ, Perel P, Piñeiro DJ, Ribeiro AL, Stepinska J. World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update. Glob Heart 2021; 16:41. [PMID: 34211827 PMCID: PMC8162289 DOI: 10.5334/gh.1023] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.
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Affiliation(s)
- Ben Freedman
- Heart Research Institute, University of Sydney, Sydney, AU
| | | | | | | | | | - Xin Du
- Beijing Anzhen Hospital, Capital Medical University, CN
| | | | | | | | - Trudie C. A. Lobban
- Arrhythmia Alliance & Atrial Fibrillation Association, Stratford Upon Avon, UK
| | - Amam Mbakwem
- Lagos University Teaching Hospital, Idi Araba, Lagos, NG
| | | | | | | | | | - Fausto J. Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisboa, PT
| | | | | | | | | | - Elena Arbelo
- Hospital Clinic de Barcelona, Universitat de Barcelona, ES
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Hornburg/Saar, DE
| | | | | | | | | | - Nitish Naik
- All India Institute of Medical Sciences, New Delhi, IN
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20
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Stavrakis S, Elkholey K, Lofgren MM, Asad ZUA, Stephens LD, Freedman B. Screening for Atrial Fibrillation in American Indian Adults in a Tribal Primary Care Clinic. J Am Heart Assoc 2021; 10:e020069. [PMID: 33878888 PMCID: PMC8200768 DOI: 10.1161/jaha.120.020069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background American Indian adults have a higher risk of atrial fibrillation (AF) compared with other racial groups. We implemented opportunistic screening to detect silent AF in American Indian adults attending a tribal health system using a mobile, single-lead ECG device. Methods and Results American Indian patients aged ≥50 years followed in a tribal primary care clinic with no history of AF underwent a 30-second ECG. A cardiologist overread all tracings to confirm the diagnosis of AF. After AF was confirmed, patients were referred to their primary care physician for initiation of anticoagulation. Patients seen over the same time period, who were not undergoing screening, served as controls. A total of 1019 patients received AF screening (mean age, 61.5±8.9 years, 62% women). Age and sex distribution of those screened was similar to the overall clinic population. New AF was diagnosed in 15 of 1019 (1.5%) patients screened versus 4 of 1267 (0.3%) patients who were not screened (mean difference, 1.2%; 95% CI, 0.3%-2.2%, P=0.002). Eight of 15 with new screen-detected AF were aged <65 years. Those with screen-detected AF were slightly older and had a higher CHA2DS2-VASc score than those without AF. Fourteen of 15 patients diagnosed with new AF had a CHA2DS2-VASc score ≥1 and initiated anticoagulation. Conclusions Opportunistic, mobile single-lead ECG screening for AF is feasible in tribal clinics, and detects more AF than usual care, leading to appropriate initiation of anticoagulation. AF develops at a younger age in American Indian adults who would likely benefit from earlier AF screening. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03740477.
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Affiliation(s)
- Stavros Stavrakis
- Heart Rhythm Institute University of Oklahoma Health Sciences Center Oklahoma City OK
| | - Khaled Elkholey
- Heart Rhythm Institute University of Oklahoma Health Sciences Center Oklahoma City OK
| | | | - Zain U A Asad
- Heart Rhythm Institute University of Oklahoma Health Sciences Center Oklahoma City OK
| | - Lancer D Stephens
- Oklahoma Shared Clinical and Translational Resources Center Oklahoma City OK
| | - Ben Freedman
- Heart Research Institute Charles Perkins Centre University of Sydney Australia
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22
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Beerten SG, Proesmans T, Vaes B. A Heart Rate Monitoring App (FibriCheck) for Atrial Fibrillation in General Practice: Pilot Usability Study. JMIR Form Res 2021; 5:e24461. [PMID: 33825692 PMCID: PMC8060868 DOI: 10.2196/24461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 12/31/2022] Open
Abstract
Background Atrial fibrillation (AF) is a major risk factor for stroke. The current opportunistic screening procedure consists of pulse palpation and an electrocardiogram when an irregular rhythm is found. Smartphone apps that measure heart rhythm could be useful in increasing the detection of AF in a primary care setting. Objective We conducted a pilot study with the smartphone app FibriCheck to assess whether the introduction of such an app is feasible. Methods Four general practices across Flanders provided patient data for the study. Inclusion criteria for participants were aged 65 or older and a CHARGE-AF score of at least 10%. We excluded patients with known AF or a pacemaker. Participants were asked to measure at least twice a day with FibriCheck (for at least 14 days). They were provided the 36-Item Short Form Survey (SF-36) questionnaire both before and after the study, as well as different surveys concerning their user experience and general perception of technology. Results There were 92 participants (36 women and 56 men). The study population was relatively homogenous concerning risk factors and medication use at baseline. During the study period, 5/86 (6%) participants were found to have AF (6 dropouts). The average study period was 23 days and the average number of measurements per day was 2.1. Patient compliance was variable, but high. On the whole, there were no appreciable changes in quality of life. The overall user experience and satisfaction were very high. Conclusions FibriCheck is a relatively easy-to-use smartphone app to complement AF screening in primary care. Its implementation in this setting is certainly achievable, and one can expect high rates of patient compliance. Based on these results, a planned cluster randomized trial will be going ahead. Trial Registration ClinicalTrials.gov NCT03509493; https://clinicaltrials.gov/ct2/show/NCT03509493
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Affiliation(s)
| | | | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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23
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. J Arrhythm 2021; 37:271-319. [PMID: 33850572 PMCID: PMC8022003 DOI: 10.1002/joa3.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de TelessaúdeHospital das Clínicasand Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queensand School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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24
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Bray JJH, Lloyd EF, Adenwalla F, Kelly S, Wareham K, Halcox JPJ. Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation. BMJ Open Qual 2021; 10:e001270. [PMID: 33741652 PMCID: PMC7986662 DOI: 10.1136/bmjoq-2020-001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/20/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Community management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting. METHODS During the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician. RESULTS Seventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF. CONCLUSIONS We have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.
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Affiliation(s)
- Jonathan James Hyett Bray
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
- General Medicine, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Elin Fflur Lloyd
- Cardiology, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Firdaus Adenwalla
- Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Sarah Kelly
- Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Kathie Wareham
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
- Morriston Hospital, Swansea, Wales, UK
| | - Julian P J Halcox
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
- Singleton Hospital, Swansea, Wales, UK
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25
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. Ann Noninvasive Electrocardiol 2021; 26:e12795. [PMID: 33513268 PMCID: PMC7935104 DOI: 10.1111/anec.12795] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queens, and School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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26
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE / HRS / EHRA / APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:7-48. [PMID: 36711170 PMCID: PMC9708018 DOI: 10.1093/ehjdh/ztab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | - Hein Heidbuchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - Yufeng Hu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of Rochester, Rochester, NY, USA
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - David Slotwiner
- Cardiology Division, NewYork-Presbyterian Queens, and School of Health, Policy and Research, Weill Cornell Medicine, New York, NY, USA
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27
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Ribeiro JM, Astudillo P, de Backer O, Budde R, Nuis RJ, Goudzwaard J, Van Mieghem NM, Lumens J, Mortier P, Mattace-Raso F, Boersma E, Cummins P, Bruining N, de Jaegere PP. Artificial Intelligence and Transcatheter Interventions for Structural Heart Disease: A glance at the (near) future. Trends Cardiovasc Med 2021; 32:153-159. [PMID: 33581255 DOI: 10.1016/j.tcm.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/16/2023]
Abstract
With innovations in therapeutic technologies and changes in population demographics, transcatheter interventions for structural heart disease have become the preferred treatment and will keep growing. Yet, a thorough clinical selection and efficient pathway from diagnosis to treatment and follow-up are mandatory. In this review we reflect on how artificial intelligence may help to improve patient selection, pre-procedural planning, procedure execution and follow-up so to establish efficient and high quality health care in an increasing number of patients.
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Affiliation(s)
- Joana Maria Ribeiro
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal; Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Ole de Backer
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ricardo Budde
- Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rutger Jan Nuis
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jeanette Goudzwaard
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Paul Cummins
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nico Bruining
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter Pt de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
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Hernandez N, Castro L, Medina-Quero J, Favela J, Michan L, Mortenson WB. Scoping Review of Healthcare Literature on Mobile, Wearable, and Textile Sensing Technology for Continuous Monitoring. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 5:270-299. [PMID: 33554008 PMCID: PMC7849621 DOI: 10.1007/s41666-020-00087-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/30/2020] [Accepted: 12/02/2020] [Indexed: 12/01/2022]
Abstract
Remote monitoring of health can reduce frequent hospitalisations, diminishing the burden on the healthcare system and cost to the community. Patient monitoring helps identify symptoms associated with diseases or disease-driven disorders, which makes it an essential element of medical diagnoses, clinical interventions, and rehabilitation treatments for severe medical conditions. This monitoring can be expensive and time-consuming and provide an incomplete picture of the state of the patient. In the last decade, there has been a significant increase in the adoption of mobile and wearable devices, along with the introduction of smart textile solutions that offer the possibility of continuous monitoring. These alternatives fuel a technology shift in healthcare, one that involves the continuous tracking and monitoring of individuals. This scoping review examines how mobile, wearable, and textile sensing technology have been permeating healthcare by offering alternate solutions to challenging issues, such as personalised prescriptions or home-based secondary prevention. To do so, we have selected 222 healthcare literature articles published from 2007 to 2019 and reviewed them following the PRISMA process under the schema of a scoping review framework. Overall, our findings show a recent increase in research on mobile sensing technology to address patient monitoring, reflected by 128 articles published in journals and 19 articles in conference proceedings between 2014 and 2019, which represents 57.65% and 8.55% respectively of all included articles.
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Affiliation(s)
- N Hernandez
- School of Computing, Campus Jordanstown, Ulster University, Newtownabbey, BT37-0QB UK
| | - L Castro
- Department of Computing and Design, Sonora Institute of Technology (ITSON), Ciudad Obregón, 85000 Mexico
| | - J Medina-Quero
- Department of Computer Science, Campus Las Lagunillas, University of Jaen, Jaén, 23071 Spain
| | - J Favela
- Department of Computer Science, Ensenada Centre for Scientific Research and Higher Education, Ensenada, 22860 Mexico
| | - L Michan
- Department of Comparative Biology, National Autonomous University of Mexico, Mexico City, 04510 Mexico
| | - W Ben Mortenson
- International Collaboration on Repair Discoveries and GF Strong Rehabilitation Research Program, University of British Columbia, Vancouver, V6T-1Z4 Canada
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Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu Y, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini JP, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:4-54. [PMID: 35265889 PMCID: PMC8890358 DOI: 10.1016/j.cvdhj.2020.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Key Words
- ACC, American College of Cardiology
- ACS, acute coronary syndrome
- AED, automated external defibrillator
- AF, atrial fibrillation
- AHA, American Heart Association
- AHRE, atrial high-rate episode
- AI, artificial intelligence
- APHRS, Asia Pacific Heart Rhythm Society
- BP, blood pressure
- CIED, cardiovascular implantable electronic device
- CPR, cardiopulmonary resuscitation
- EHR A, European Heart Rhythm Association
- EMR, electronic medical record
- ESUS, embolic stroke of unknown source
- FDA (U.S.), Food and Drug Administration
- GPS, global positioning system
- HCP, healthcare professional
- HF, heart failure
- HR, heart rate
- HRS, Heart Rhythm Society
- ICD, implantable cardioverter-defibrillator
- ILR, implantable loop recorder
- ISHNE, International Society for Holter and Noninvasive Electrocardiology
- JITAI, just-in-time adaptive intervention
- MCT, mobile cardiac telemetry
- OAC, oral anticoagulant
- PAC, premature atrial complex
- PPG, photoplethysmography
- PVC, premature ventricular complexes
- SCA, sudden cardiac arrest
- TADA, Technology Assissted Dietary Assessment
- VT, ventricular tachycardia
- arrhythmias
- atrial fibrillation
- comorbidities
- digital medicine
- heart rhythm
- mHealth
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Affiliation(s)
| | | | | | - Hein Heidbuchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - Yufeng Hu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of Rochester, Rochester, NY, USA
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - David Slotwiner
- Cardiology Division, NewYork-Presbyterian Queens, and School of Health Policy and Research, Weill Cornell Medicine, New York, NY, USA
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Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu YF, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini JP, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society. Circ Arrhythm Electrophysiol 2021; 14:e009204. [PMID: 33573393 PMCID: PMC7892205 DOI: 10.1161/circep.120.009204] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society describes the current status of mobile health technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mobile health. The promises of predictive analytics but also operational challenges in embedding mobile health into routine clinical care are explored.
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Affiliation(s)
- Niraj Varma
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | | | | | | | - Yu-Feng Hu
- Taipei Veterans General Hospital, Taiwan (Y.-F.H.)
| | | | | | | | | | | | | | - Reena Mehra
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | - Alex Page
- University of Rochester, NY (J.-P.C., A.P., J.S.S.)
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL (R. Passman)
| | | | - Ewa Piotrowicz
- National Institute of Cardiology, Warsaw, Poland (E.P., R. Piotrowicz)
| | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.)
| | | | - Andrea M. Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | - David Slotwiner
- Cardiology Division, New York-Presbyterian Queens, NY (D.S.)
| | | | - Emma Svennberg
- Karolinska University Hospital, Stockholm, Sweden (E.S.)
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5414] [Impact Index Per Article: 1804.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Zink MD, Mischke KG, Keszei AP, Rummey C, Freedman B, Neumann G, Tolksdorf A, Frank F, Wienströer J, Kuth N, Schulz JB, Marx N. Screen-detected atrial fibrillation predicts mortality in elderly subjects. Europace 2021; 23:29-38. [PMID: 33020819 PMCID: PMC7842093 DOI: 10.1093/europace/euaa190] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023] Open
Abstract
AIMS Current guidelines recommend opportunistic screening for atrial fibrillation (AF) but the prognosis of individuals is unclear. The aim of this investigation is to determine prevalence and 1-year outcome of individuals with screen-detected AF. METHODS AND RESULTS We performed a prospective, pharmacy-based single time point AF screening study in 7107 elderly citizens (≥65 years) using a hand-held, single-lead electrocardiogram (ECG) device. Prevalence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Mean age of participants was 74 ± 5.9 years, with 58% (N = 4130) of female sex. Automated heart rhythm analyses identified AF in 432 (6.1%) participants, with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalized for CV causes. Total mortality was 2.3% in participants with a screen-detected AF and 0.8% in subjects with a normal ECG [hazard ratio (HR) 2.94; 95% confidence interval (CI) 1.49-5.78; P = 0.002]; hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI 1.52-2.84; P < 0.001). Compared with subjects without a history of AF at baseline and a normal ECG, participants with newly diagnosed or known AF had a significantly higher mortality risk with HRs of 2.64 (95% CI 1.05-6.66; P = 0.04) and 2.68 (95% CI 1.44-4.97; P = 0.002), respectively. After multivariable adjustment, screen-detected AF remained a significant predictor of death or hospitalization for CV causes. CONCLUSION Pharmacy-based, automated AF screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next year.
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Affiliation(s)
- Matthias D Zink
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, D-52074 Aachen, Germany
- Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Maastricht, the Netherlands
| | - Karl G Mischke
- Department of Internal Medicine I, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Andras P Keszei
- Center for Translational and Clinical Research, RWTH Aachen University, Aachen, Germany
| | | | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, Concord Hospital Cardiology, University of Sydney, Camperdown, Australia
| | | | - Alina Tolksdorf
- Department of General Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Friederike Frank
- Department of General Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jan Wienströer
- Department of Medical Informatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Nicole Kuth
- Department of General Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, D-52074 Aachen, Germany
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May Measurement Month 2017-2019: A Community-Wide Opportunistic Blood Pressure Screening Campaign in Hong Kong. Int J Hypertens 2021; 2021:8891794. [PMID: 33532095 PMCID: PMC7834825 DOI: 10.1155/2021/8891794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/17/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Hypertension is a modifiable risk factor for multiple cardiovascular diseases. Early identification and intervention of new cases are crucial to improve patients' outcomes. May Measurement Month (MMM) is an annual global synchronised blood pressure (BP) screening campaign. Participants can have their BP measured at the screening sites. It may be a possible way to identify undiagnosed hypertensive patients in the population. Methods It was a cross-sectional study of BP among Hong Kong adults. Multiple screening sites were set in local community pharmacies and on the campus of the Chinese University of Hong Kong. Participants were asked to fill in a questionnaire regarding their demographics, medical history, and social history. Then, they took at least one BP reading using an automated sphygmomanometer after sitting at for 5 minutes. Up to three BP readings were taken and recorded for each participant, with one-minute intervals between readings. Results A total of 3224 adults participated in MMM between 2017 and 2019. The average BP among the 3224 participants was 139.8/75.5 mmHg. The prevalence of hypertension was 2282 (70.8%), of which 635 (27.8%) were undiagnosed before MMM. Among the 1647 participants previously diagnosed with hypertension, 1007 (61.1%) had uncontrolled hypertension. Conclusion A high number of cases can be identified with untreated, or treated but uncontrolled, hypertension from MMM. Citizens should be encouraged to check BP regularly and take follow-up actions if hypertension is suspected.
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Zhang J, Johnsen SP, Guo Y, Lip GYH. Epidemiology of Atrial Fibrillation: Geographic/Ecological Risk Factors, Age, Sex, Genetics. Card Electrophysiol Clin 2021; 13:1-23. [PMID: 33516388 DOI: 10.1016/j.ccep.2020.10.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation is the most common arrhythmia globally. The global prevalence of atrial fibrillation is positively correlated with the sociodemographic index of different regions. Advancing age, male sex, and Caucasian race are risk factors; female sex is correlated with higher atrial fibrillation mortality worldwide likely owing to thromboembolic risk. African American ethnicity is associated with lower atrial fibrillation risk, same as Asian and Hispanic/Latino ethnicities compared with Caucasians. Atrial fibrillation may be heritable, and more than 100 genetic loci have been identified. A polygenic risk score and clinical risk factors are feasible and effective in risk stratification of incident disease.
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Affiliation(s)
- Juqian Zhang
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, L14 3PE, UK
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Aalborg, Aalborg 9000, Denmark
| | - Yutao Guo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, L14 3PE, UK; Department of Cardiology, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, L14 3PE, UK; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Aalborg, Aalborg 9000, Denmark; Department of Cardiology, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.
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35
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Alberti E, Stucchi L, Pesce V, Stancari G, Ferro E, Ferrucci F, Zucca E. Evaluation of a smartphone-based electrocardiogram device accuracy in field and in hospital conditions in horses. Vet Rec Open 2020; 7:e000441. [PMID: 33381302 PMCID: PMC7754639 DOI: 10.1136/vetreco-2020-000441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/20/2020] [Accepted: 11/12/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Due to compactness and cheapness, smartphone ECG (sECG) could be very useful to equine practitioners. However, previous studies have evaluated the accuracy of sECG in hospitalised horses only. Different conditions in the field could influence the accuracy of the device. The aim of this study is to compare the accuracy of sECG in field and in hospital conditions. METHODS This is a prospective study. Paired standard base-apex ECG (stECG) and sECG were recorded in hospitalised horses and in subjects examined in field conditions. ECGs were analysed for heart rate and rhythm, presence/type of arrhythmias, presence/duration of artefacts, electrocardiographic waves and interval parameters by a blinded clinician. Statistical analysis evaluated the agreement between stECG and sECG and the differences in the prevalence of artefact in field and hospital conditions. RESULTS Nineteen (hospital) and 40 (field) paired ECGs were analysed. Agreement between stECG and sECG was found for heart rate and rhythm, evaluation of atrioventricular block and premature complexes, P wave and PQ interval duration, and QRS complex duration and polarity. No differences were found between artefacts recorded in hospital and in field conditions. CONCLUSION sECG is a feasible tool for evaluation of rhythm in horses and is as accurate in field as in ambulatory conditions.
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Affiliation(s)
- Elena Alberti
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
| | - Luca Stucchi
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
| | | | - Giovanni Stancari
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
| | - Elisabetta Ferro
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
| | - Francesco Ferrucci
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
| | - Enrica Zucca
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Lodi, Italy
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Jawad-Ul-Qamar M, Chua W, Purmah Y, Nawaz M, Varma C, Davis R, Maher A, Fabritz L, Kirchhof P. Detection of unknown atrial fibrillation by prolonged ECG monitoring in an all-comer patient cohort and association with clinical and Holter variables. Open Heart 2020; 7:openhrt-2019-001151. [PMID: 32371464 PMCID: PMC7223355 DOI: 10.1136/openhrt-2019-001151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/12/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Prolonged ECG monitoring is clinically useful to detect unknown atrial fibrillation (AF) in stroke survivors. The diagnostic yield of prolonged ECG monitoring in other patient populations is less well characterised. We therefore studied the diagnostic yield of prolonged Holter ECG monitoring for AF in an unselected patient cohort referred from primary care or seen in a teaching hospital. METHODS We analysed consecutive 7-day ECG recordings in unselected patients referred from different medical specialities and assessed AF detection rates by indication, age and comorbidities. RESULTS Seven-day Holter ECGs (median monitoring 127.5 hours, IQR 116 to 152) were recorded in 476 patients (mean age 54.6 (SD 17.0) years, 55.9% female) without previously known AF, requested to evaluate palpitations (n=241), syncope (n=99), stroke or transient ischaemic attack (n=75), dizziness (n=29) or episodic chest pain (n=32). AF was newly detected in 42/476 (8.8%) patients. Oral anticoagulation was initiated in 40/42 (95.2%) patients with newly detected AF. Multivariate logistic regression, adjusted for age, sex and monitoring duration found four clinical parameters to be associated with newly detected AF: hypertension OR=2.54, (1.08 to 8.61) (adjusted OR (95% CI)), p=0.034; previous stroke or TIA OR=4.14 (1.81 to 13.01), p=0.001; left-sided valvular heart disease OR=5.07 (2.48 to 18.70), p<0.001 and palpitations OR=2.86, (1.33 to 10.44), p=0.015. CONCLUSIONS Open multispeciality access to prolonged ECG monitoring, for example, as part of integrated, cross-sector AF care, can accelerate diagnosis of AF and increase adequate use of oral anticoagulation, especially in older and symptomatic patients with comorbidities.
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Affiliation(s)
- Muhammad Jawad-Ul-Qamar
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yanish Purmah
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Mohammad Nawaz
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Chetan Varma
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Russell Davis
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Abdul Maher
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK .,Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK.,University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
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Ng VWS, Siu CW, Chiu PKC, Kng CPL, Jamieson E, Wong ICK, Lam MPS. Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation - a qualitative study. BMC Health Serv Res 2020; 20:1084. [PMID: 33238989 PMCID: PMC7691100 DOI: 10.1186/s12913-020-05947-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF. METHOD Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis. RESULTS Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers. CONCLUSION The findings revealed patients' knowledge gap in AF management which may be targeted using educational interventions to improve patients' understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.
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Affiliation(s)
- Vanessa W S Ng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Patrick K C Chiu
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Carolyn P L Kng
- Division of Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong SAR, China
| | - Elizabeth Jamieson
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China.,Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - May P S Lam
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China.
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DeVore AD, Wosik J, Hernandez AF. The Future of Wearables in Heart Failure Patients. JACC-HEART FAILURE 2020; 7:922-932. [PMID: 31672308 DOI: 10.1016/j.jchf.2019.08.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 01/28/2023]
Abstract
The adoption of mobile health (mHealth) devices is creating a unique opportunity to improve heart failure (HF) care. The rise of mHealth is driven by multiple factors including consumerism, policy changes in health care, and innovations in technology. Wearable health devices are one aspect of mHealth that may improve the delivery of HF care by allowing for medical data collection outside of a clinician's office or hospital. Wearable devices are externally applied and capture functional or physiological data in order to monitor and improve patients' health. Most wearable sensors capture data continuously and may be incorporated into accessories (e.g., a watch or clothing) or may be applied as a cutaneous patch. Wearable devices are often paired with another device, such as a smartphone, to collect, interpret, or transmit data. This study assessed the potential applications of wearable devices in HF care, summarizes available data for wearables, and discusses the future of wearables for improving the health of patients with HF.
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Affiliation(s)
- Adam D DeVore
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
| | - Jedrek Wosik
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Adrian F Hernandez
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Yu L, Ye X, Yang Z, Yang W, Zhang B. Prevalences and associated factors of electrocardiographic abnormalities in Chinese adults: a cross-sectional study. BMC Cardiovasc Disord 2020; 20:414. [PMID: 32917144 PMCID: PMC7488680 DOI: 10.1186/s12872-020-01698-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022] Open
Abstract
Background Electrocardiogram (ECG) is widely used to screen cardiac diseases. To date, no large population study has provided estimates of the prevalences of ECG findings in China. We aim to investigate the prevalences and associated factors of ECG abnormalities in a general population of Chinese adults. Methods ECG data were obtained from 34,965 participants in the 2007–2008 China National Diabetes and Metabolic Disorders Study. ECG abnormalities were classified according to the Minnesota coding (MC) criteria. Prevalences of variant ECG abnormalities were calculated. The associations between ECG abnormalities and gender, age and other risk factors for cardiovascular diseases (CVD) were analyzed by multivariate logistic regression test. Results The prevalences of major arrhythmias were 1.70, 2.37 and 1.04% in the whole population, men and women, respectively. Atrial fibrillation/flutter was found in 0.35% of men and 0.20% of women. ST depression and T abnormalities accounted for 10.96, 7.54 and 14.32% in the whole population, men and women, respectively. Independent of gender and other CVD risk factors, older age significantly increased the odds of having atrial fibrillation/flutter, complete left bundle branch block, complete right bundle branch block, sinus tachycardia, atrial/junctional/ventricular premature beats, ST depression and T abnormalities, tall R wave left, left/right atrial hypertrophy, left axis deviation and low voltage. Hypertension, overweight, obesity and hypercholesterolemia all independently increased the odds of having ST depression and T abnormalities. History of cardiovascular/cerebrovascular diseases was positively associated with major arrhythmias, ST depression and T abnormalities and tall R wave left. Conclusions This study provides estimates of the prevalences of ECG findings in a large population of Chinese adults. Gender, age, CVD risk factors and history of cardiovascular/cerebrovascular diseases were significantly associated with ECG abnormalities.
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Affiliation(s)
- Liping Yu
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaojun Ye
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Zhaojun Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
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Rivezzi F, Vio R, Bilato C, Pagliani L, Pasquetto G, Saccà S, Verlato R, Migliore F, Iliceto S, Bossone V, Bertaglia E. Screening of unknown atrial fibrillation through handheld device in the elderly. J Geriatr Cardiol 2020; 17:495-501. [PMID: 32952524 PMCID: PMC7475215 DOI: 10.11909/j.issn.1671-5411.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of unknown atrial fibrillation (AF) in the elderly population of the Veneto Region, Italy. METHODS 1820 patients aged ≥ 65 years with no history of AF and not anticoagulated were enrolled in primary-care settings. They underwent an opportunistic electrocardiogram screening with a handheld device (MyDiagnostick) designed to specifically detect AF. The electrocardiogram recordings were reviewed by the researchers, who confirmed the presence of AF. RESULTS The device detected an arrhythmia in 143 patients, which was confirmed as AF in 101/143 (70.6%), with an overall prevalence of AF of 5.5% (101/1820). Prevalence of unknown AF resulted in 3.6% in patients aged 65-74 years, and 7.5% in patients age 75 or older, and increased according to CHA2DS2-VASc score: 3.5% in patients with a score of 1 or 2, 5.6% in patients with a score of 3, 7.0% in patients with a score of 4, and 7.2% in patients with a score ≥ 5. The detection rate was significantly higher in patients with mild symptoms compared to asymptomatic counterparts (24.1% vs. 4.0%, P < 0.0001). At multivariate analysis, congestive heart failure and age ≥ 75 years-old were independent predictors for screen-detected AF. CONCLUSIONS An opportunistic screening with handheld device revealed an unexpectedly high prevalence of unknown AF in elderly patients with mild symptoms. Prevalence increased with age and CHA2DS2-VASc score.
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Affiliation(s)
- Francesco Rivezzi
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Riccardo Vio
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | | | - Giampaolo Pasquetto
- Division of Cardiology, "Riuniti Hospitals Padova Sud", Monselice, Padova, Italy
| | - Salvatore Saccà
- Department of Cardiology, General Hospital, Mirano, Venezia, Italy
| | - Roberto Verlato
- Division of Cardiology, Pietro Cosma Hospital, Camposampiero, Padova, Italy
| | - Federico Migliore
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Emanuele Bertaglia
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Emanuele Bertaglia, MD, PhD, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy. E-mail:
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Hall A, Mitchell ARJ, Wood L, Holland C. Effectiveness of a single lead AliveCor electrocardiogram application for the screening of atrial fibrillation: A systematic review. Medicine (Baltimore) 2020; 99:e21388. [PMID: 32791751 PMCID: PMC7386997 DOI: 10.1097/md.0000000000021388] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Increasing prevalence of atrial fibrillation has a significant impact on health, society, and healthcare resource utilization, due to increased morbidity, mortality, risk of stroke, and reduction in quality of life. Early diagnosis allows for treatment initiation, a reduction in complications and associated costs, and so innovation to improve screening and enable easy access are needed Developments in digital technology have significantly contributed to the availability of screening tools. The single-lead electrocardiogram AliveCor (Mountainview, CA) device offers the opportunity to provide heart rhythm screening and has been used extensively in clinical practice and research studies. METHODS This review investigates the feasibility, validity, and utility of the AliveCor device as a tool for atrial fibrillation detection in clinical practice and in wider research. Databases searched included PUBMED, CINAHL, MEDLINE, and World of Science, plus grey literature search. Search terms related to atrial fibrillation, screening, and AliveCor with adults >18 years. Feasibility metrics were applied including process, resource, management, and scientific outcomes. Studies not written in the English language were excluded. Validity of AliveCor was explored by extracting sensitivity and specificity data from eligible studies and overall effectiveness analyzed by incorporating the above, with wider issues surrounding screening approaches, cost effectiveness and appropriateness of AliveCor as a screening tool. RESULTS The AliveCor device screening was reviewed in 11 studies matching inclusion criteria. Atrial fibrillation detection rates ranged from 0.8% to 36% and this largely correlated to the study population, where wider age inclusion and mass/population screening represented lower atrial fibrillation detection. Recruitment from higher-risk groups (older age, targeted localities, chronic disease) identified higher numbers with atrial fibrillation. Feasibility metrics demonstrated AliveCor as an effective tool of choice in terms of process, resources, and management. Duration of screening time had an impact on rates of atrial fibrillation detection. There was however significant heterogeneity between studies reviewed. CONCLUSION The AliveCor device offers a convenient, valid, and feasible means of monitoring for atrial fibrillation. Further analysis of electrocardiograms produced by AliveCor may be necessary in some circumstances. The AliveCor electrocardiogram device can be successfully implemented into both opportunistic and systematic screening strategies for atrial fibrillation.
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Kochav SM, Reiffel JA. Detection of Previously Unrecognized (Subclinical) Atrial Fibrillation. Am J Cardiol 2020; 127:169-175. [PMID: 32423696 DOI: 10.1016/j.amjcard.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022]
Abstract
Atrial fibrillation (AF) has been associated with increased morbidity and mortality, even when symptoms are absent and the arrhythmia is unrecognized (e.g., subclinical AF [SCAF]). Despite substantial evidence demonstrating an association between AF and adverse outcomes, the role of mass screening for previously unrecognized SCAF, such that its individual and population risks may be reduced by prophylactic therapy, remains uncertain. Many AF screening strategies exist, from pulse palpation and single-use devices to implanted cardiac monitors; however, existing guidelines are insufficient in specifying who to screen and for how long. In general, higher age, more (and more severe) comorbidities, and longer monitoring periods are associated with greater detection of SCAF. Herein we review the significance of previously unrecognized SCAF and current status of SCAF detection methods. We then propose a clinical approach to help clinicians incorporate AF screening into their practice. In conclusion, we report that SCAF may not be rare, that inserted cardiac monitors have the highest yield of SCAF detection, that clinical concern regarding SCAF is appropriate, but that evidence for therapy mandates is still being collected.
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Savickas V, Stewart AJ, Rees-Roberts M, Short V, Bhamra SK, Corlett SA, Mathie A, Veale EL. Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: A cross-sectional feasibility study. PLoS Med 2020; 17:e1003197. [PMID: 32678820 PMCID: PMC7367445 DOI: 10.1371/journal.pmed.1003197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Growing prevalence of atrial fibrillation (AF) in the ageing population and its associated life-changing health and resource implications have led to a need to improve its early detection. Primary care is an ideal place to screen for AF; however, this is limited by shortages in general practitioner (GP) resources. Recent increases in the number of clinical pharmacists within primary care makes them ideally placed to conduct AF screening. This study aimed to determine the feasibility of GP practice-based clinical pharmacists to screen the over-65s for AF, using digital technology and pulse palpation during the influenza vaccination season. METHODS AND FINDINGS Screening was conducted over two influenza vaccination seasons, 2017-2018 and 2018-2019, in four GP practices in Kent, United Kingdom. Pharmacists were trained by a cardiologist to pulse palpate, record, and interpret a single-lead ECG (SLECG). Eligible persons aged ≥65 years (y) attending an influenza vaccination clinic were offered a free heart rhythm check. Six hundred four participants were screened (median age 73 y, 42.7% male). Total prevalence of AF was 4.3%. All participants with AF qualified for anticoagulation and were more likely to be male (57.7%); be older; have an increased body mass index (BMI); and have a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, previous Stroke, Vascular disease, Age 65-74 years, Sex category) score ≥ 3. The sensitivity and specificity of clinical pharmacists diagnosing AF using pulse palpation was 76.9% (95% confidence interval [CI] 56.4-91.0) and 92.2% (95% CI 89.7-94.3), respectively. This rose to 88.5% (95% CI 69.9-97.6) and 97.2% (95% CI 95.5-98.4) with an SLECG. At follow-up, four participants (0.7%) were diagnosed with new AF and three (0.5%) were initiated on anticoagulation. Screening with SLECG also helped identify new non-AF cardiovascular diagnoses, such as left ventricular hypertrophy, in 28 participants (4.6%). The screening strategy was cost-effective in 71.8% and 64.3% of the estimates for SLECG or pulse palpation, respectively. Feedback from participants (422/604) was generally positive. Key limitations of the study were that the intervention did not reach individuals who did not attend the practice for an influenza vaccination and there was a limited representation of UK ethnic minority groups in the study cohort. CONCLUSIONS This study demonstrates that AF screening performed by GP practice-based pharmacists was feasible, economically viable, and positively endorsed by participants. Furthermore, diagnosis of AF by the clinical pharmacist using an SLECG was more sensitive and more specific than the use of pulse palpation alone. Future research should explore the key barriers preventing the adoption of national screening programmes.
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Affiliation(s)
- Vilius Savickas
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Adrian J. Stewart
- Medway Maritime Hospital, Cardiology, Gillingham, Kent, United Kingdom
| | - Melanie Rees-Roberts
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Vanessa Short
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
- Newton Place Surgery, Faversham, United Kingdom
| | - Sukvinder K. Bhamra
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Sarah A. Corlett
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Alistair Mathie
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Emma L. Veale
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
- * E-mail:
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Chen Y, Huang QF, Sheng CS, Zhang W, Shao S, Wang D, Cheng YB, Wang Y, Guo QH, Zhang DY, Li Y, Lowres N, Freedman B, Wang JG. Detection rate and treatment gap for atrial fibrillation identified through screening in community health centers in China (AF-CATCH): A prospective multicenter study. PLoS Med 2020; 17:e1003146. [PMID: 32673305 PMCID: PMC7365395 DOI: 10.1371/journal.pmed.1003146] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is underdiagnosed and especially undertreated in China. We aimed to investigate the prevalence of unknown and untreated AF in community residents (≥65 years old) and to determine whether an education intervention could improve oral anticoagulant (OAC) prescription. METHODS AND FINDINGS We performed a single-time point screening for AF with a handheld single-lead electrocardiography (ECG) in Chinese residents (≥65 years old) in 5 community health centers in Shanghai from April to September 2017. Disease education and advice on referral to specialist clinics for OAC treatment were provided to all patients with actionable AF (newly detected or undertreated known AF) at the time of screening, and education was reinforced at 1 month. Follow-up occurred at 12 months. In total, 4,531 participants were screened (response rate 94.7%, mean age 71.6 ± 6.3 years, 44% male). Overall AF prevalence was 4.0% (known AF 3.5% [n = 161], new AF 0.5% [n = 22]). The 183 patients with AF were older (p < 0.001), taller (p = 0.02), and more likely to be male (p = 0.01), and they had a higher prevalence of cardiovascular disease than those without AF (p < 0.001). In total, 85% (155/183) of patients were recommended for OAC treatment by the established guidelines (CHA2DS2-VASc ≥ 2 for men; ≥ 3 for women). OAC prescription rate for known AF was 20% (28/138), and actionable AF constituted 2.8% of all those screened. At the 12-month follow-up in 103 patients (81% complete), despite disease education and advice on specialist referral, only 17 attended specialist clinics, and 4 were prescribed OAC. Of those not attending specialist clinics, 71 chose instead to attend community health centers or secondary hospital clinics, with none prescribed OAC, and 15 had no review. Of the 17 patients with new AF and a class 1 recommendation for OAC, only 3 attended a specialist clinic, and none were prescribed OAC. Of the 28 AF patients taking OAC at baseline, OAC was no longer taken in 4. Ischemic stroke (n = 2) or death (n = 3) occurred in 5/126 (4%), with none receiving OAC. As screening was performed at a single time point, some paroxysmal AF cases may have been missed; thus, the rate of new AF may be underestimated. CONCLUSIONS We demonstrated a noticeable gap in AF detection and treatment in community-based elderly Chinese: actionable AF constituted a high proportion of those screened. Disease education and advice on specialist referral are insufficient to close the gap. Before more frequent or intensive screening for unknown AF could be recommended in China, greater efforts must be made to increase appropriate OAC therapy in known AF to prevent AF-related stroke.
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Affiliation(s)
- Yi Chen
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Sheng Sheng
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhang
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuai Shao
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dian Wang
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong-Yan Zhang
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nicole Lowres
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Sydney Medical School, Charles Perkins Center, and Cardiology Department, Concord Hospital, The University of Sydney, Sydney, Australia
| | - Ji-Guang Wang
- Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
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Abstract
Atrial fibrillation (AF) is a common and morbid arrhythmia. Stroke is a major hazard of AF and may be preventable with oral anticoagulation. Yet since AF is often asymptomatic, many individuals with AF may be unaware and do not receive treatment that could prevent a stroke. Screening for AF has gained substantial attention in recent years as several studies have demonstrated that screening is feasible. Advances in technology have enabled a variety of approaches to facilitate screening for AF using both medical-prescribed devices as well as consumer electronic devices capable of detecting AF. Yet controversy about the utility of AF screening remains owing to concerns about potential harms resulting from screening in the absence of randomized data demonstrating effectiveness of screening on outcomes such as stroke and bleeding. In this review, we summarize current literature, present technology, population-based screening considerations, and consensus guidelines addressing the role of AF screening in practice.
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Affiliation(s)
- Shaan Khurshid
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
- Cardiology Division, Massachusetts General Hospital, Boston, MA
- Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge, MA
| | - Jeffrey S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, CA
| | - William F. McIntyre
- Population Health Research Institute, McMaster University, Hamilton, Ontario, CA
| | - Steven A. Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
- Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge, MA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA
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Abstract
Atrial fibrillation (AF) is a major cause of morbidity and mortality globally, and much of this is driven by challenges in its timely diagnosis and treatment. Existing and emerging mobile technologies have been used to successfully identify AF in a variety of clinical and community settings, and while these technologies offer great promise for revolutionizing AF detection and screening, several major barriers may impede their effectiveness. The unclear clinical significance of device-detected AF, potential challenges in integrating patient-generated data into existing healthcare systems and clinical workflows, harm resulting from potential false positives, and identifying the appropriate scope of population-based screening efforts are all potential concerns that warrant further investigation. It is crucial for stakeholders such as healthcare providers, researchers, funding agencies, insurers, and engineers to actively work together in fulfilling the tremendous potential of mobile technologies to improve AF identification and management on a population level.
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Affiliation(s)
- Eric Y Ding
- From the Department of Population and Quantitative Health Sciences and Division of Cardiology, Department of Medicine, University of Massachusetts Medical School (E.Y.D., D.D.M.)
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - David D McManus
- From the Department of Population and Quantitative Health Sciences and Division of Cardiology, Department of Medicine, University of Massachusetts Medical School (E.Y.D., D.D.M.)
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Duarte R, Stainthorpe A, Greenhalgh J, Richardson M, Nevitt S, Mahon J, Kotas E, Boland A, Thom H, Marshall T, Hall M, Takwoingi Y. Lead-I ECG for detecting atrial fibrillation in patients with an irregular pulse using single time point testing: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-164. [PMID: 31933471 PMCID: PMC6983912 DOI: 10.3310/hta24030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with an increased risk of stroke and congestive heart failure. Lead-I electrocardiogram (ECG) devices are handheld instruments that can be used to detect AF at a single time point in people who present with relevant signs or symptoms. OBJECTIVE To assess the diagnostic test accuracy, clinical impact and cost-effectiveness of using single time point lead-I ECG devices for the detection of AF in people presenting to primary care with relevant signs or symptoms, and who have an irregular pulse compared with using manual pulse palpation (MPP) followed by a 12-lead ECG in primary or secondary care. DATA SOURCES MEDLINE, MEDLINE Epub Ahead of Print and MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PubMed, Cochrane Databases of Systematic Reviews, Cochrane Central Database of Controlled Trials, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database. METHODS The systematic review methods followed published guidance. Two reviewers screened the search results (database inception to April 2018), extracted data and assessed the quality of the included studies. Summary estimates of diagnostic accuracy were calculated using bivariate models. An economic model consisting of a decision tree and two cohort Markov models was developed to evaluate the cost-effectiveness of lead-I ECG devices. RESULTS No studies were identified that evaluated the use of lead-I ECG devices for patients with signs or symptoms of AF. Therefore, the diagnostic accuracy and clinical impact results presented are derived from an asymptomatic population (used as a proxy for people with signs or symptoms of AF). The summary sensitivity of lead-I ECG devices was 93.9% [95% confidence interval (CI) 86.2% to 97.4%] and summary specificity was 96.5% (95% CI 90.4% to 98.8%). One study reported limited clinical outcome data. Acceptability of lead-I ECG devices was reported in four studies, with generally positive views. The de novo economic model yielded incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) gained. The results of the pairwise analysis show that all lead-I ECG devices generated ICERs per QALY gained below the £20,000-30,000 threshold. Kardia Mobile (AliveCor Ltd, Mountain View, CA, USA) is the most cost-effective option in a full incremental analysis. LIMITATIONS No published data evaluating the diagnostic accuracy, clinical impact or cost-effectiveness of lead-I ECG devices for the population of interest are available. CONCLUSIONS Single time point lead-I ECG devices for the detection of AF in people with signs or symptoms of AF and an irregular pulse appear to be a cost-effective use of NHS resources compared with MPP followed by a 12-lead ECG in primary or secondary care, given the assumptions used in the base-case model. FUTURE WORK Studies assessing how the use of lead-I ECG devices in this population affects the number of people diagnosed with AF when compared with current practice would be useful. STUDY REGISTRATION This study is registered as PROSPERO CRD42018090375. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rui Duarte
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Angela Stainthorpe
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Janette Greenhalgh
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Marty Richardson
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - James Mahon
- Coldingham Analytical Services, Berwickshire, UK
| | - Eleanor Kotas
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Howard Thom
- Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mark Hall
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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Duarte R, Stainthorpe A, Mahon J, Greenhalgh J, Richardson M, Nevitt S, Kotas E, Boland A, Thom H, Marshall T, Hall M, Takwoingi Y. Lead-I ECG for detecting atrial fibrillation in patients attending primary care with an irregular pulse using single-time point testing: A systematic review and economic evaluation. PLoS One 2019; 14:e0226671. [PMID: 31869370 PMCID: PMC6927656 DOI: 10.1371/journal.pone.0226671] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with increased risk of stroke and congestive heart failure. Lead-I electrocardiogram (ECG) devices are handheld instruments that can detect AF at a single-time point. PURPOSE To assess the diagnostic test accuracy, clinical impact and cost effectiveness of single-time point lead-I ECG devices compared with manual pulse palpation (MPP) followed by a 12-lead ECG for the detection of AF in symptomatic primary care patients with an irregular pulse. METHODS Electronic databases (MEDLINE, MEDLINE Epub Ahead of Print and MEDLINE In-Process, EMBASE, PubMed and Cochrane Databases of Systematic Reviews, Cochrane Central Database of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database) were searched to March 2018. Two reviewers screened the search results, extracted data and assessed study quality. Summary estimates of diagnostic accuracy were calculated using bivariate models. Cost-effectiveness was evaluated using an economic model consisting of a decision tree and two cohort Markov models. RESULTS Diagnostic accuracy The diagnostic accuracy (13 publications reporting on nine studies) and clinical impact (24 publications reporting on 19 studies) results are derived from an asymptomatic population (used as a proxy for people with signs or symptoms of AF). The summary sensitivity of lead-I ECG devices was 93.9% (95% confidence interval [CI]: 86.2% to 97.4%) and summary specificity was 96.5% (95% CI: 90.4% to 98.8%). Cost effectiveness The de novo economic model yielded incremental cost effectiveness ratios (ICERs) per quality adjusted life year (QALY) gained. The results of the pairwise analysis show that all lead-I ECG devices generate ICERs per QALY gained below the £20,000-£30,000 threshold. Kardia Mobile is the most cost effective option in a full incremental analysis. Lead-I ECG tests may identify more AF cases than the standard diagnostic pathway. This comes at a higher cost but with greater patient benefit in terms of mortality and quality of life. LIMITATIONS No published data evaluating the diagnostic accuracy, clinical impact or cost effectiveness of lead-I ECG devices for the target population are available. CONCLUSIONS The use of single-time point lead-I ECG devices in primary care for the detection of AF in people with signs or symptoms of AF and an irregular pulse appears to be a cost effective use of NHS resources compared with MPP followed by a 12-lead ECG, given the assumptions used in the base case model. REGISTRATION The protocol for this review is registered on PROSPERO as CRD42018090375.
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Affiliation(s)
- Rui Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Angela Stainthorpe
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - James Mahon
- Coldingham Analytical Services, Berwickshire, United Kingdom
| | - Janette Greenhalgh
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Marty Richardson
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Nevitt
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Eleanor Kotas
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Howard Thom
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Mark Hall
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
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Jatau AI, Peterson GM, Bereznicki L, Dwan C, Black JA, Bezabhe WM, Wimmer BC. Applying the Capability, Opportunity, and Motivation Behaviour Model (COM-B) to Guide the Development of Interventions to Improve Early Detection of Atrial Fibrillation. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819885134. [PMID: 31700252 PMCID: PMC6823978 DOI: 10.1177/1179546819885134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 10/02/2019] [Indexed: 12/31/2022]
Abstract
Objective: The primary objective of this study is to use the Capability, Opportunity, and Motivation Behaviour (COM-B) model to identify potential strategies aimed at improving the early detection of atrial fibrillation (AF) in the general population. Methods: We undertook a review of the literature to identify factors associated with participation in community-based screening for AF, followed by mapping of the factors generated into the components of the COM-B model, and validation of the model by an expert panel. The Behaviour Change Wheel (BCW) was used to nominate potential intervention strategies and steps to guide the design and implementation of community-based screening for AF. Results: A total of 28 factors from 21 studies were mapped into the COM-B model. Based on the BCW approach, 24 intervention strategies and 7 steps that could guide the design and implementation of community-based screening for AF were recommended. Conclusion: The application of the COM-B model demonstrated how factors influencing the participation of individuals with undiagnosed AF in community-based screening could be identified. The model could also serve as a guide for the design and implementation of interventions for improving AF detection in the general population.
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Affiliation(s)
- Abubakar Ibrahim Jatau
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Gregory M Peterson
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Luke Bereznicki
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Corinna Dwan
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - J Andrew Black
- Cardiology department, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Woldesellassie M Bezabhe
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Barbara C Wimmer
- Pharmacy, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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Ramkumar S, Ochi A, Yang H, Nerlekar N, D’Elia N, Potter EL, Murray IC, Nattraj N, Wang Y, Marwick TH. Association between socioeconomic status and incident atrial fibrillation. Intern Med J 2019; 49:1244-1251. [DOI: 10.1111/imj.14214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Satish Ramkumar
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
- School of Public Health and Preventative MedicineMonash University Melbourne Victoria Australia
- Monash Heart, Monash Cardiovascular Research Centre Melbourne Victoria Australia
| | - Ayame Ochi
- Menzies Institute for Medical Research Hobart Tasmania Australia
| | - Hong Yang
- Menzies Institute for Medical Research Hobart Tasmania Australia
| | - Nitesh Nerlekar
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
- Monash Heart, Monash Cardiovascular Research Centre Melbourne Victoria Australia
| | - Nicholas D’Elia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Elizabeth L. Potter
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
- School of Public Health and Preventative MedicineMonash University Melbourne Victoria Australia
| | | | - Nishee Nattraj
- Menzies Institute for Medical Research Hobart Tasmania Australia
| | - Ying Wang
- Menzies Institute for Medical Research Hobart Tasmania Australia
| | - Thomas H. Marwick
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
- School of Public Health and Preventative MedicineMonash University Melbourne Victoria Australia
- Menzies Institute for Medical Research Hobart Tasmania Australia
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