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Subclinical Atrial Fibrillation Screening in Dialytic Chronic Kidney Disease Patients Using Portable Device
Adson Patrik Vieira Carvalho1, Gabriel Assis Lopes do Carmo1, Cassia Aparecida Silva2
1Faculdade de Medicina - Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil.
Insights
A portable device effectively screened hemodialysis patients for atrial fibrillation (AF), showing high sensitivity and a negative predictive value of 100%. This technology can help detect undiagnosed AF in this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Medical Devices
Background:
- Hemodialysis (HD) patients exhibit elevated cardiovascular risks, including a higher prevalence of arrhythmias like atrial fibrillation (AF).
- Atrial fibrillation is a significant independent risk factor for mortality and thromboembolic events in dialysis patients.
- Accurate AF prevalence data is crucial for managing cardiovascular health in HD populations, yet screening remains challenging.
Purpose of the Study:
- To implement and assess a portable device for screening atrial fibrillation (AF) in hemodialysis patients.
- To evaluate the diagnostic performance of the portable screening device in this specific patient group.
Main Methods:
- AF screening was conducted on 388 hemodialysis patients during dialysis sessions using the portable MyDiagnostick® device.
- Data on patient demographics, clinical factors, and dialysis parameters were collected for association analysis.
- Statistical significance was determined using a p-value threshold of less than 0.05.
Main Results:
- The screening identified 16 patients (4.1%) with potential AF, and 7 (1.8%) were confirmed by electrocardiogram.
- Factors associated with positive AF screening included male sex, older age, pre-existing ECG abnormalities, elevated potassium, lower systolic blood pressure, and stable angina.
- The device demonstrated high diagnostic accuracy with 100% sensitivity and 91.74% specificity for AF detection.
Conclusions:
- The portable device is a practical tool for AF screening in hemodialysis patients, offering high sensitivity and an excellent negative predictive value.
- Subclinical atrial fibrillation is highly prevalent in this population and may be frequently underestimated.
- This technology offers a pioneering approach to improving cardiovascular risk assessment in hemodialysis patients.
Background:
Cardiovascular morbidity and mortality rates are higher in hemodialysis (HD) patients, with an increased prevalence of arrhythmias. Atrial fibrillation (AF) is an independent risk factor for mortality and thromboembolic events in dialysis patients. For a better understanding and management of AF in these patients, it is important to know its prevalence. The use of a portable device would be pioneering for this group of patients.
Objective:
To screen HD patients for AF using a portable gadget and evaluate the device's diagnostic performance.
Methods:
HD patients at a tertiary hospital underwent AF screening during HD sessions using MyDiagnostick® (Applied Biomedical Systems). Multiple data were collected to evaluate potential associations. Statistical significance was defined as p < 0.05.
Results:
388 patients were evaluated (female, 40.7%; mean age of 56.8 years old, SD ± 14.7; and HD time of 27 months, 10-57). Screening was positive in 16 (4.1%) patients. AF was confirmed by electrocardiogram in 7 (1.8%) patients. Male sex (p = 0.019), older age (p = 0.007), altered baseline electrocardiogram (p < 0.001), increased serum potassium (p = 0.021), reduced systolic blood pressure at the beginning of dialysis (p = 0.007), and stable angina (0.011) were associated with positive screening for AF. The device presented a 91.74% specificity (95% CI, 86.65% to 96.91%) and 100% sensitivity (95% CI, 100% to 100%), with a negative predictive value of 100% (95% CI, 100% to 100%) for AF screening.
Conclusion:
The use of this device proved to be practical, with high sensitivity and excellent negative predictive value. Subclinical AF has a high prevalence and may be underestimated in this population.
