Screening for atrial fibrillation in high-risk nursing home residents

Various methods have been implemented for screening of patients for atrial fibrillation (AF), but the yield has generally been low. Targeting high-risk patients may improve detection of asymptomatic AF, which could be of value if appropriate treatment could be initiated before a potential thromboembolic event.

The purpose of this study was to test screening of high-risk nursing home residents having ≥2 risk factors for AF and no previous history of AF using a smartphone-based electrocardiographic (ECG) monitoring device to determine whether it is an accurate, easy-to-use method of screening for asymptomatic AF.

Study participants had ≥2 risk factors, consisting of age ≥75 years, female sex, obstructive sleep apnea, peripheral vascular disease, diabetes mellitus, obesity, hypertension, and congestive heart failure. Using the monitoring device, 30-second heart rhythm recordings were obtained on 4 different occasions. All tracings were reviewed by a cardiologist and, if uncertain, by an electrophysiologist. The nursing facility was notified of any diagnosis of AF, prompting further evaluation by the primary physician.

Of the 245 residents screened, 18 (7.4%) had a diagnostic tracing for AF, 15 (83.3%) of whom had AF on the initial screen. There were no significant differences in demographics or individual risk factors between residents with and those without AF.

Intermittent ECG screening of high-risk nursing home residents using a simple, handheld device provided a diagnostic yield in our population comparable to that observed in past studies. Such screening of high-risk individuals can aid in the early diagnosis of AF and initiation of appropriate treatment.