Screening for atrial fibrillation in hospitalised geriatric patients

Heart. 2018 Apr;104(7):588-593. doi: 10.1136/heartjnl-2017-311981. Epub 2017 Sep 7.

Abstract

Objectives: To assess whether daily short-term rhythm strip recordings on top of routine clinical care could increase the atrial fibrillation (AF) detection rate in the hospitalised elderly.

Methods: A hand-held device storing a bipolar ECG during 1 min was used for daily rhythm recording in hospitalised elderly patients.

Results: During 2 months, all patients admitted to the Department of Geriatric Medicine were screened (n=327). Five patients refused to participate in the study and 70 patients were unable to hold the device due to severe mental (n=46) or motor impairment (n=24). In the remaining 252 patients, 1582 recordings were successfully obtained after 1624 attempts with a median acquisition time of 1 min (min 1, max 9, IQR 1-2 min). The rhythm strips were not reliable interpretable due to artefacts in three patients or an implantable cardiac pulse generator in another 28 patients. Detailed clinical information was available in 214/221 patients. Mean age was 84±6 years. On top of 71 (33%) patients with AF identified by routine clinical care (history, n=64 or de novo detected during current hospitalisation, n=7), review of all rhythm strips identified another 28 patients (13%) with AF. All these patients had a CHA2DS2VASc score ≥2. A contraindication for anticoagulation was present in only 8/28 (25%) of identified patients.

Conclusions: On top of routine clinical care, daily short-term rhythm strip recordings identified another 13% of elderly hospitalised patients with AF, leading to an overall prevalence of 46% in hospitalised patients. This can have significant therapeutic implications with respect to initiation of anticoagulation.

Keywords: atrial fibrillation; elderly; screening.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / therapy
  • Belgium / epidemiology
  • Electrocardiography* / instrumentation
  • Electrocardiography* / methods
  • Female
  • Geriatric Assessment / methods
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / methods*
  • Prevalence
  • Reproducibility of Results

Substances

  • Anticoagulants