Atrial fibrillation detection with a portable device during cardiovascular screening in primary care

Abstract

IntroductionA novel handheld dual-electrode stick is a portable atrial fibrillation (AF) screening device (AFSD). We evaluated AFSD performance in primary care patients referred for echocardiogram (echo).MethodsThe AFSD has a light indication of irregular rhythm and single-lead ECG recording. Patients were instructed to hold the device for 1 min, and AF indication was recorded. A 12-lead ECG was performed for all AFSD-positive patients and 250 patients with negative AFSD screen. Echos were performed based on a clinical risk score: all high-risk patients and a sampling of low-risk patients underwent complete echo. Intermediate risk patients first had a screening echocardiogram, with a follow-up complete study if abnormality was suspected.ResultsIn 5 days, 1518 patients underwent clinical evaluation and cardiovascular risk stratification: mean age 58±16 years, 66% women. The AFSD was positive in 6.4%: 12.6% high risk, 6.1% intermediate risk and 2.2% low risk. Older age was a risk factor (9.3% vs 4.8% in those more than and less than 65 years, p=0.001). AFSD positive was independently associated with heart disease in echo (OR=3.9, 95% CI 2.1 to 7.2, p<0.001). Compared with 12-lead ECG, the AFSD had sensitivity of 90.2% (95% CI 77.0% to 97.3%) and specificity of 84.0% (95% CI 79.3% to 88.0%) for AF detection.ConclusionAFSD demonstrated high sensitivity for AF detection in primary care patients referred for echo. AF prevalence was substantial and independently associated with structural or functional heart disease, suggesting that AFSD screening could be a useful primary care tool to stratify risk and prioritise echo.

Estatística Cardiovascular – Brasil 2021

“…Os autores sugerem que rastrear FA possa ser útil na atenção primária para estratificar risco e priorizar o ecocardiograma. 228 • Insuficiência cardíaca e FA coexistem em muitos pacientes, pois compartilham vias fisiopatológicas similares. Em um estudo retrospectivo de 659 pacientes hospitalizados por insuficiência cardíaca descompensada em 2011, a prevalência de FA foi de 40% (73% FA permanente), estando a FA associada ao avançar da idade (p < 0,0001), etiologia não isquêmica (p = 0,02), disfunção ventricular direita (p = 0,03), pressão sistólica mais baixa (p = 0,02), maior fração de ejeção (p < 0,0001) e aumento do átrio esquerdo (p < 0,0001).…”

“…•Há espaço para aprimorar o diagnóstico cardíaco remoto no Brasil, através da expansão do tele-ECG, do rastreio de FA, 228 das consultas remotas – incluindo aquelas para condições infecciosas, como a COVID-19 229 – e da incorporação das inovações em técnicas de imagem para melhorar o acesso ao cuidado cardiovascular. São necessárias extensas discussões baseadas em robustas evidências científicas.…”

“…Os autores sugerem que rastrear FA possa ser útil na atenção primária para estratificar risco e priorizar o ecocardiograma. 228 …”

Estatística Cardiovascular – Brasil 2020

“…233 Apesar do seu bom desempenho para diagnóstico e discriminação de pacientes com alto risco cardiovascular, 234 o impacto sobre os desfechos clínicos, assim como a viabilidade e a custo-efetividade da estratégia, ainda aguardam avaliação. À semelhança do observado para outras novas modalidades, como tele-ECG, rastreio de FA 235 e consultas remotas, a incorporação das inovações em técnicas de imagem para melhorar o acesso ao cuidado cardiovascular no Brasil pode requerer extensas discussões baseadas em sólida evidência científica. dos pacientes; FA paroxística, 25%; FA persistente, 14%; e FA permanente, 8%.…”

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

“…A number of stand-alone handheld or chest-applied ECG devices, or small inexpensive devices attached to a smartphone, are available and commonly used as event recorders providing an ECG rhythm strip for AF diagnosis when symptoms are suggestive or to estimate AF burden in known AF. These devices can also be used to screen for AF by either health professionals or personnel with minimal training in LMICs [ 25 95 ] or by individuals themselves [ 96 97 ], with single or multiple intermittent ECG 30-second snapshots [ 50 ]. As a 30-second rhythm strip is considered sufficient for AF diagnosis, this may be the preferred technology for making an AF diagnosis after non-ECG devices or pulse-based screening.…”