Introduction Atrial fibrillation (AF) is the most common arrhythmia and its incidence rises with age. Especially geriatric patients are at high risk for the development of AF as well as its complications. These high risk patients might benefit the most of oral anticoagulation. AF is however often asymptomatic in these patients and might stay undiagnosed. Purpose To assess the outcomes of opportunistic screening on AF on a geriatric outpatient clinic with a hand held single lead ECG device. Methods All consecutive patients 60 years and older that visited the outpatient clinic between the 1st of June 2017 and the 1st of June 2018 were eligible. Patients who were not able or willing to give informed consent, or had a pacemaker (PM) or internal cardioverter defibrillator (ICD) were excluded. Patients were screened 2 or 3 times at every visit with the MyDiagnostick©, a hand held single lead ECG device with inbuilt algorithm that identifies AF [1]. At baseline all patients underwent a comprehensive geriatric assessment (CGA), including a 12 lead ECG, physical, cognitive and functional assessment and medication review. All baseline ECGs were reviewed by 1 cardiologist and all measurements with the single lead device were reviewed by 2 independent cardiologists. Disagreement about the rhythm on the measurements was resolved by discussion between the cardiologists. Results 498 consecutive patients were eligible for inclusion. We excluded 39 patients: 20 patients had a PM or ICD, 17 did not want to participate and of 2 the medical files were incomplete. A total of 459 patients participated in this study. The mean age was 78±7.3 years and ranged from 60 to 100 years, 245 patients (53%) were female. Patients were known with 5±3 morbidities and used 6±4 different drugs. At baseline 88 (19%) patients were known with AF and AF was first diagnosed in 24 (5%) patients, constituting to an overall prevalence of 23% within this ambulatory geriatric population. Of these 24 patients, 4 (1%) showed AF on their baseline ECG and in 20 (4%) patients AF was found using the handheld device. A total of 1345 measurement with the handheld device were performed, 14 measurements (1%) were of too low quality to use, 32 (2%) were of poor quality, 148 (11%) acceptable and 1151 (86%) were of good quality. Sensitivity of the hand held device for detecting AF is 83.9%, specificity 99.2%, negative predictive value 99.6%, and positive predictive value 72.2%. Conclusions Opportunistic screening for AF with a hand held ECG device has a 5 times higher yield than the standard CGA with an 12 lead ECG at the first visit only. Also, AF can be reliably excluded after a negative measurement. Because of the potential benefit of OAC we advocate screening geriatric patients for AF at every doctor's visit. However, considering the positive predictive value, a confirmatory ECG remains necessary to confirm the diagnosis of AF. Acknowledgement/Funding None
Aims Screening for atrial fibrillation (AF) is recommended by the European Society of Cardiology guideline to prevent strokes. Cost-effectiveness analyses of different screening programs for AF are difficult to compare, because of varying settings and models used. We compared the impact and cost-effectiveness of various AF screening programs in the Netherlands. Methods and results The base case economic analysis was conducted from the societal perspective. Health effects and costs were analysed using a Markov model. The main model inputs were derived from the ARISTOTLE, RE-LY and ROCKET AF trial combined with Dutch observational data. Univariate, probabilistic sensitivity and various scenario analyses were performed. The maximum number of newly detected AF patients in The Netherlands ranged from 4554 to 39 270, depending on the screening strategy used. Adequate treatment with anticoagulation would result in a maximum of more than 3000 strokes prevented using single time point AF screening. Compared with no screening, screening 100 000 persons provided a gain in QALYs ranging from 984 to 8727, and a mean cost difference ranging from -6650 000€ to 898 000€, depending on the screening strategy used. Probabilistic sensitivity analysis (PSA) demonstrated a 100% likelihood that screening all patients ≥ 75 years visiting the Geriatric outpatient clinic was cost-saving. Four out of six strategies were cost-saving in ≥ 74% of the PSA simulations. Out of these, opportunistic screening of all patients ≥ 65 years visiting the GPs office had the highest impact on strokes prevented. Conclusion Most single-time point AF screening strategies are cost-saving and have an important impact on stroke prevention.
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