Introduction A 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).
Methods The 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.
Results In 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.
Conclusion AFSD 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.
- atrial fibrillation
- cardiac risk factors and prevention
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Presented at The abstract of this work was presented at the American Heart Association Scientific Sessions, 16–18 November 2019, in Philadelphia, Pennsylvania, USA.
Contributors Conception and design of the research: BN, LCB, Ribeiro, AL and CS; acquisition of data: AD, MdCPN, KKO, LCR, MMB,Tompsett AR, LO, MDM, WAAC, AFP and LCD; analysis and interpretation of data: BN, LCB, AB, CS and LCD; statistical analysis: BN and LCB; obtaining financing: AB, CS, BN and Ribeiro, AL; writing of the manuscript: BN and LCB; critical revision of the manuscript for intellectual content: all authors; authors responsible for the overall content as guarantors: BN and AB.
Funding This study was funded by Edwards Lifesciences Foundation, USA. The AFSD devices were purchased by the project, and the manufacturer did not have any relationship with the conduct of the study, the collection, analysis, and interpretation of the data. The Telehealth Network of Minas Gerais was funded by the State Government of Minas Gerais, by its Health Department (Secretaria de Estado da Saúde de Minas Gerais) and FAPEMIG (Fundação de Amparo à Pesquisa de Minas Gerais), and by the Brazilian Government, including the Health Ministry and the Science and Technology Ministry and its research and innovation agencies, CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) e FINEP (Financiadora de Estudos e Projetos). Dr. Ribeiro was supported in part by CNPq (Bolsa de produtividade em pesquisa, 310679/2016–8) and by FAPEMIG (Programa Pesquisador Mineiro, PPM-00 428–17). Medical students received scholarships from the National Institute of Science and Technology for Health Technology Assessment (IATS, project: 465518/2014–1).
Competing interests None declared.
Patient and public involvement statement Patients and public were not involved in the design and conduct of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. The data analytic methods and study materials will be made available to other researchers for purposes of reproducing the results or replicating the procedure from the corresponding author on reasonable request.