Prevalence of atrial fibrillation and stroke risk assessment based on telemedicine screening tools in a primary healthcare setting

Moraes, Eraldo Ribeiro Ferreira Leão de; Cirenza, Cláudio; Lópes, Renato D.; Carvalho, Antônio Carlos; Guimarães, Patrícia O.; Rodrigues, Alfredo Augusto Eyer; Paola, Ângelo Amato Vincenzo de

doi:10.1016/j.ejim.2019.04.024

Cited by 21 publications

(24 citation statements)

References 35 publications

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“…The clinical factors that we identified allow to improve patient targeting in screening initiatives, and this may facilitate the organizational aspects, which have to consider as key elements the specificity of the setting, the need for adequate information to potential candidates on the scope and implications of screening, as well as the definition of pathways for direct referral after AF diagnosis to physicians (general practitioners or cardiologists) in charge of clinical evaluation and decision making [22,35]. Our standard for AF diagnosis was the 12-lead ECG, in line with current European guidelines [14] and previous experiences [30,36]. For practical reasons we did not adopt the alternative possibility of AF diagnosis based on a single-lead ECG tracing showing AF with at least 30 s duration, analyzed by an expert in ECG reading [14].…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Atrial Fibrillation Detection on Single-Time Point Screening Using a Hand-Held Single-Lead ECG Device

Boriani

Palmisano²,

Malavasi

et al. 2021

JCM

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Our aim was to assess the prevalence of unknown atrial fibrillation (AF) among adults during single-time point rhythm screening performed during meetings or social recreational activities organized by patient groups or volunteers. A total of 2814 subjects (median age 68 years) underwent AF screening by a handheld single-lead ECG device (MyDiagnostick). Overall, 56 subjects (2.0%) were diagnosed with AF, as a result of 12-lead ECG following a positive/suspected recording. Screening identified AF in 2.9% of the subjects ≥ 65 years. None of the 265 subjects aged below 50 years was found positive at AF screening. Risk stratification for unknown AF based on a CHA2DS2VASc > 0 in males and >1 in females (or CHA2DS2VA > 0) had a high sensitivity (98.2%) and a high negative predictive value (99.8%) for AF detection. A slightly lower sensitivity (96.4%) was achieved by using age ≥ 65 years as a risk stratifier. Conversely, raising the threshold at ≥75 years showed a low sensitivity. Within the subset of subjects aged ≥ 65 a CHA2DS2VASc > 1 in males and >2 in females, or a CHA2DS2VA > 1 had a high sensitivity (94.4%) and negative predictive value (99.3%), while age ≥ 75 was associated with a marked drop in sensitivity for AF detection.

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Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Atrial Fibrillation Detection on Single-Time Point Screening Using a Hand-Held Single-Lead ECG Device

Boriani

Palmisano²,

Malavasi

et al. 2021

JCM

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“…As known, RM can be used with the purpose of remote device check or for monitoring patients' status (heart rhythm, fluid overload, right ventricular pressure, oximetry, etc. ), thus with a shift from strictly device-centred follow-up to perspectives centred on the patient (and patient-device interactions) [23][24][25][26][27][28]. The organization of disease management of heart failure, though RM in patients with implanted devices is complex, requires an interplay between the competence on devices and heart failure management and, therefore, should be object of promotion for the post-COVID-19 recovery phase.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 pandemic on the clinical activities related to arrhythmias and electrophysiology in Italy: results of a survey promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Boriani

Palmisano²,

Guerra

et al. 2020

Intern Emerg Med

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COVID-19 outbreak had a major impact on the organization of care in Italy, and a survey to evaluate provision of for arrhythmia during COVID-19 outbreak (March-April 2020) was launched. A total of 104 physicians from 84 Italian arrhythmia centres took part in the survey. The vast majority of participating centres (95.2%) reported a significant reduction in the number of elective pacemaker implantations during the outbreak period compared to the corresponding two months of year 2019 (50.0% of centres reported a reduction of > 50%). Similarly, 92.9% of participating centres reported a significant reduction in the number of implantable cardioverter-defibrillator (ICD) implantations for primary prevention, and 72.6% a significant reduction of ICD implantations for secondary prevention (> 50% in 65.5 and 44.0% of the centres, respectively). The majority of participating centres (77.4%) reported a significant reduction in the number of elective ablations (> 50% in 65.5% of the centres). Also the interventional procedures performed in an emergency setting, as well as acute management of atrial fibrillation had a marked reduction, thus leading to the conclusion that the impact of COVID-19 was disrupting the entire organization of health care, with a massive impact on the activities and procedures related to arrhythmia management in Italy.

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“…In this subset of participants from EMMA study, we found just one participant under NOAC. Although NOACs are available in Brazil for more than a decade, as previously reported by other authors 31 , its use is low or almost inexistent among people with low-socioeconomic status because, unlike warfarin, there is no free availability of NOACs in Brazilian primary care units. A recent primary care-based cross-sectional study (2009-2016) reaffirmed our data.…”

Section: Af Related Stroke Outcomes and Anticoagulationmentioning

confidence: 91%

The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity

Goulart

Olmos

Santos

et al. 2021

International Journal of Stroke

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Background: Atrial fibrillation (AF) is a predictor of poor prognosis after stroke. Aims: To evaluate AF and all-cause and cardiovascular (CVD) mortality in a stroke cohort with low socioeconomic status (SES), taking into consideration oral anticoagulant (OAC) use during 12-year follow-up. Methods: All-cause mortality was analyzed by Kaplan-Meier survival curve and Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). For specific mortality causes, cumulative incidence functions were computed. A logit link function was used to calculate odds ratios (OR) with 95% CIs. Full models were adjusted by age, sex, OAC use (as a time-dependent variable) and cardiovascular risk factors. Results: Of 1,121 ischemic stroke (IS) participants, 17.8 % had AF. Overall, 654 deaths (58.3%) were observed. Survival rate was lower (median days, interquartile range-IQR) among those with AF (531, IQR: 46-2,039) vs. non-AF (1,808, IQR: 334-3,301), p-log rank <0.0001). Over 12-year follow-up, previous AF was associated with increased mortality: all-cause (multivariable HR, 1.82; 95%CI: 1.43-2.31) and CVD mortality (multivariable OR, 2.07; 95%CI: 1.36-3.14), but not stroke mortality. In the same multivariable models, OAC use was inversely associated with all-cause mortality (OAC time-dependent effect: multivariable HR, 0.47; 95%CI: 0.30-0.50, p=0.002) and stroke mortality (OAC time-dependent effect â¥ 6 months: multivariable OR, 0.09; 95% CI: 0.01-0.65, p-value=0.02), but not CVD mortality. Conclusions: Among individuals with low SES, AF was an independent predictor of poor survival, increasing all-cause and CVD mortality risk. Long-term OAC use was associated with a markedly reduced risk of all-cause and stroke mortality.

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Prevalence of atrial fibrillation and stroke risk assessment based on telemedicine screening tools in a primary healthcare setting

Cited by 21 publications

References 35 publications

Clinical Factors Associated with Atrial Fibrillation Detection on Single-Time Point Screening Using a Hand-Held Single-Lead ECG Device

Clinical Factors Associated with Atrial Fibrillation Detection on Single-Time Point Screening Using a Hand-Held Single-Lead ECG Device

Impact of COVID-19 pandemic on the clinical activities related to arrhythmias and electrophysiology in Italy: results of a survey promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

The impact of atrial fibrillation and long-term oral anticoagulant use on all-cause and cardiovascular mortality: A 12-year evaluation of the prospective Brazilian Study of Stroke Mortality and Morbidity

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