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Published on: February 26, 2013
Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: VITAL-AF Randomized Controlled Trial
Steven A Lubitz1,2, Steven J Atlas3, Jeffrey M Ashburner3,2
1Demoulas Center for Cardiac Arrhythmias and Cardiovascular Research Center (S.A.L., S.K., P.T.E.), Massachusetts General Hospital, Boston.
Insights
Point-of-care screening for atrial fibrillation (AF) using a handheld ECG in primary care did not increase new AF diagnoses in patients aged 65+. Further research is needed for older adults.
Area of Science:
- Cardiology
- Primary Care Medicine
- Medical Devices
Background:
- Undiagnosed atrial fibrillation (AF) poses a risk for preventable strokes.
- Current AF screening guidelines lack consensus.
- The study addresses the need for effective AF detection strategies in primary care settings.
Purpose of the Study:
- To evaluate the effectiveness of point-of-care screening for AF using a handheld single-lead ECG during primary care visits.
- To determine if this screening method increases the diagnosis of AF in patients aged 65 years and older.
Main Methods:
- A randomized controlled trial involving 16 primary care clinics.
- Patients aged ≥65 years were randomized to either AF screening with a handheld ECG or usual care.
- New AF diagnoses were ascertained over a 1-year follow-up period.
Main Results:
- No significant difference in new AF diagnoses between the screening and usual care groups (1.72% vs. 1.59%).
- A higher incidence of new AF diagnoses was observed in the screening group among patients aged ≥85 years (5.56% vs. 3.76%).
- Oral anticoagulant initiation rates were similar in both groups for newly diagnosed AF patients.
Conclusions:
- Point-of-care screening for AF with a handheld ECG in primary care did not increase overall new AF diagnoses in individuals aged 65+.
- Screening may be more beneficial in older subgroups (≥85 years).
- The study did not find a difference in oral anticoagulant initiation between groups.
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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