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Published on: February 26, 2013
High Burden of Unrecognized Atrial Fibrillation in Rural India: An Innovative Community-Based Cross-Sectional
Apurv Soni1, Allison Earon, Anna Handorf
1University of Massachusetts Medical School, Worcester, MA, United States. apurv.soni@umassmed.edu.
Insights
A study in rural India found a 5.1% prevalence of atrial fibrillation, a key stroke risk factor, using mobile ECG screening. This highlights the need for accessible screening in low-resource areas to prevent strokes.
Area of Science:
- Cardiology
- Public Health
- Medical Technology
Background:
- Atrial fibrillation is the most common heart arrhythmia and a major cause of stroke, affecting millions globally.
- Stroke incidence in India is high, with limited resources hindering conventional screening for atrial fibrillation.
- Early detection of atrial fibrillation is crucial for stroke prevention, especially in underserved populations.
Purpose of the Study:
- To screen for atrial fibrillation in rural western India using a portable ECG device.
- To assess the feasibility of mobile health technology for arrhythmia detection in resource-limited settings.
Main Methods:
- A population of 354 residents aged 50+ from 6 villages in Gujarat, India, were enrolled.
- Participants underwent a 2-minute single-lead ECG recording daily for 5 consecutive days using the Alivecor device.
- Screenings were conducted in participants' residences over a 6-week period starting June 2015.
Main Results:
- The sample prevalence of atrial fibrillation was 5.1% (95% CI 2.7-8.7).
- Most participants were older adults, female, had limited formal education, and low household income.
- Only one participant had persistent atrial fibrillation; 9 screened positive once.
Conclusions:
- The identified atrial fibrillation prevalence in this Indian region is higher than previously reported in India.
- Mobile ECG technology offers a viable solution for overcoming resource limitations in atrial fibrillation screening.
- Increased screening may reveal a higher burden of atrial fibrillation in low- and middle-income countries.
Background:
Atrial fibrillation, the world's most common arrhythmia, is a leading risk factor for stroke, a disease striking nearly 1.6 million Indians annually. Early detection and management of atrial fibrillation is a promising opportunity to prevent stroke but widespread screening programs in limited resource settings using conventional methods is difficult and costly.
Objective:
The objective of this study is to screen people for atrial fibrillation in rural western India using a US Food and Drug Administration-approved single-lead electrocardiography device, Alivecor.
Methods:
Residents from 6 villages in Anand District, Gujarat, India, comprised the base population. After obtaining informed consent, a team of trained research coordinators and community health workers enrolled a total of 354 participants aged 50 years and older and screened them at their residences using Alivecor for 2 minutes on 5 consecutive days over a period of 6 weeks beginning June, 2015.
Results:
Almost two-thirds of study participants were 55 years or older, nearly half were female, one-third did not receive any formal education, and more than one-half were from households earning less than US $2 per day. Twelve participants screened positive for atrial fibrillation yielding a sample prevalence of 5.1% (95% CI 2.7-8.7). Only one participant had persistent atrial fibrillation throughout all of the screenings, and 9 screened positive only once.
Conclusions:
Our study suggests a prevalence of atrial fibrillation in this Indian region (5.1%) that is markedly higher than has been previously reported in India and similar to the prevalence estimates reported in studies of persons from North America and Europe. Historically low reported burden of atrial fibrillation among individuals from low and middle-income countries may be due to a lack of routine screening. Mobile technologies may help overcome resource limitations for atrial fibrillation screening in underserved and low-resource settings.
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