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General population screening for atrial fibrillation with an automated rhythm-detection blood pressure device
Gentian Denas1, Alessandro Battaggia2, Massimo Fusello3
1Cardiology Clinic, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy.
Insights
Screening for atrial fibrillation (AF), including silent AF (SAF), in older adults using automated devices in general practice detected a higher incidence rate. This simple protocol may be feasible for large-scale screening to reduce strokes.
Area of Science:
- Cardiology
- Public Health
- Geriatrics
Background:
- Undetected atrial fibrillation (AF), particularly silent AF (SAF), poses a significant stroke risk.
- Screening at-risk populations is crucial for early diagnosis and stroke prevention.
Purpose of the Study:
- To assess the incidence rate of AF, including SAF, in individuals aged 65 and older using an automated device in a general practitioner (GP) setting.
- To evaluate the feasibility of large-scale AF and SAF screening in routine primary care.
Main Methods:
- A prospective, population-based study involving 14,987 participants aged ≥65 years without a prior AF diagnosis.
- Automated AF-detection capable sphygmomanometers were used in primary care settings, with AF diagnoses confirmed by 12-lead ECG or Holter monitoring.
- Data collection occurred between February 2018 and April 2019, accumulating 16,838 patient-years of follow-up.
Main Results:
- The overall incidence rate of AF was 2.25% per patient-year.
- Silent AF (SAF) accounted for one in four detected AF cases (0.56% per patient-years).
- Risk factors for AF included male sex, older age, overweight, prior stroke, congestive heart failure, and chronic kidney disease. Age, overweight, and visit frequency predicted both AF and SAF.
Conclusions:
- The study identified a higher incidence rate of AF than previously reported, likely due to the detection of SAF.
- The implemented screening protocol using automated devices is potentially feasible for widespread implementation in routine GP care for AF and SAF detection.
Background:
Screening strategies to diagnose previously undetected atrial fibrillation (AF), especially silent AF (SAF), in at-risk populations may help reduce the number of strokes. We prospectively assessed the incidence rate of AF, including SAF, using an automated AF-detection capable sphygmomanometer in the General Practitioner (GP) setting.
Methods:
This was a population-based prospective study of unselected general population of ≥65 years without prior AF. Participating GPs were requested, in the period February 2018-April 2019, to record all AF diagnoses including those derived from the AF-detection capable sphygmomanometer and confirmed by 12‑lead ECG or ECG Holter in asymptomatic patients.
Results:
Overall, 14,987 patients assisted by 76 GPs accumulated 16,838 patient-years of follow up. The incidence rate of AF was 2.25% patient-years (95%CI 2.03-2.48). AF was more frequently detected in male, older, overweight, and patients with prior stroke, congestive heart failure, and chronic kidney disease. One in four patients had device-detected SAF (0.56% patient-years, 95%CI 0.46-0.69). Age, overweight, and the number of annual visits, were independent predictors of both SAF and AF. In addition, congestive heart failure, mitral valve disease were independent predictors of AF. Due to the interaction between blood pressure and age the risk of AF increased exponentially after 75 years of age in patients with higher systolic blood pressure values.
Conclusion:
We found a higher than previously reported incidence rate of AF possibly by capturing SAF. Our simple protocol might be feasible in large-scale screening for AF and SAF in routine GP care.
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