Screening for atrial fibrillation in 13 122 Hong Kong citizens with smartphone electrocardiogram

The purpose of this study was to assess the feasibility of community screening for atrial fibrillation (AF) using a smartphone-based wireless single-lead ECG (SL-ECG) and to generate epidemiological data on the prevalence and risk factors of AF in Hong Kong.

In the period between 1 May 2014 to 30 April 2015, 13 122 Hong Kong citizens consented and voluntarily participated in a territory-wide community-based AF screening programme.

56 (0.4%) out of 13 122 SL-ECG were uninterpretable. 101 (0.8%) participants had newly diagnosed AF, with 66 (65.3%) being asymptomatic. The congestive heart failure, hypertension, age>75(doubled), diabetes, stroke(doubled), vascular disease, age 65-74, sex(female) score (CHA₂DS₂VASc score) of participants with newly diagnosed AF was 3.1±1.3. The prevalence rates for AF detected by SL-ECG was 1.8% and for AF detected by SL-ECG or self-reported by participants was 8.5%. Using multivariable logistic regression analysis, independent predictors of AF include age, sex, height, weight, body mass index, history of heart failure, valvular heart disease, stroke, hyperlipidaemia, coronary artery disease, peripheral artery disease and cardiothoracic surgery.

Community screening for AF with SL-ECG was feasible and it identified a significant proportion of citizens with newly diagnosed AF. The prevalence of AF in a Chinese population in Hong Kong was comparable with that of contemporary Western counterparts. Apart from age and sex, different anthropometric parameters and cardiovascular comorbid conditions were identified as independent predictors of AF.