Atrial fibrillation case finding in over 65 s with cardiovascular risk factors

Results of initial Scottish clinical experience

Neil R Grubb (Lead / Corresponding author), Douglas Elder, Paul Broadhurst, Anne Reoch, Emma Tassie, Aileen Neilson

    Research output: Contribution to journalArticle

    Abstract

    BACKGROUND: Atrial fibrillation (AF) is a major preventable risk factor for stroke and may be silent in elderly individuals who are at especially high risk. This paper describes the first phase of implementation of a clinical AF detection programme in a community setting. Objectives were (i) to determine the feasibility of using a handheld ECG recording system for AF detection among individuals aged 65 years or more, who have cardiovascular risk factors. (ii) to estimate the yield of previously undiagnosed atrial fibrillation cases, and the proportion of these who would be suitable for oral anticoagulation.

    METHODS: a handheld ECG monitor was placed in each of 23 primary care practices across Scotland. Eligible patients attending for annual health checks had ECGs recorded, and the ECGs were transmitted and interpreted by two senior cardiologists. ECG quality was rated, and an adjudication made on the rhythm. For patients confirmed with AF, stroke and bleeding risk were estimated using CHA2DS2-VASc and HAS-BLED scoring tools.

    RESULTS: single lead ECGs were recorded in 1805 patients (703 female and 1102 male), mean (SD) age 74.9 (7.1) years. Rhythm regularity could be assessed in 98.7% of ECGs recorded. 92 patients (5.1%) were found to have AF. Median [range]CHA2DS2-VASc score was 4 ([2-7) and median [range] HAS-BLED score was 2 (1-5).

    CONCLUSION: handheld ECG recording can be used to identify AF in the primary care setting, with minimal training. The yield was relatively high.

    Original languageEnglish
    Pages (from-to)94-99
    Number of pages6
    JournalInternational journal of cardiology
    Volume288
    Early online date29 Mar 2019
    DOIs
    Publication statusPublished - 1 Aug 2019

    Fingerprint

    Atrial Fibrillation
    Electrocardiography
    Primary Health Care
    Stroke
    Scotland
    Hemorrhage
    Health

    Keywords

    • Ambulatory monitoring
    • Atrial fibrillation
    • Public health
    • Screening
    • Stroke
    • Telehealth

    Cite this

    Grubb, Neil R ; Elder, Douglas ; Broadhurst, Paul ; Reoch, Anne ; Tassie, Emma ; Neilson, Aileen. / Atrial fibrillation case finding in over 65 s with cardiovascular risk factors : Results of initial Scottish clinical experience. In: International journal of cardiology. 2019 ; Vol. 288. pp. 94-99.
    @article{9a49d3931f6444a183b5bd60c4b2cfd1,
    title = "Atrial fibrillation case finding in over 65 s with cardiovascular risk factors: Results of initial Scottish clinical experience",
    abstract = "BACKGROUND: Atrial fibrillation (AF) is a major preventable risk factor for stroke and may be silent in elderly individuals who are at especially high risk. This paper describes the first phase of implementation of a clinical AF detection programme in a community setting. Objectives were (i) to determine the feasibility of using a handheld ECG recording system for AF detection among individuals aged 65 years or more, who have cardiovascular risk factors. (ii) to estimate the yield of previously undiagnosed atrial fibrillation cases, and the proportion of these who would be suitable for oral anticoagulation.METHODS: a handheld ECG monitor was placed in each of 23 primary care practices across Scotland. Eligible patients attending for annual health checks had ECGs recorded, and the ECGs were transmitted and interpreted by two senior cardiologists. ECG quality was rated, and an adjudication made on the rhythm. For patients confirmed with AF, stroke and bleeding risk were estimated using CHA2DS2-VASc and HAS-BLED scoring tools.RESULTS: single lead ECGs were recorded in 1805 patients (703 female and 1102 male), mean (SD) age 74.9 (7.1) years. Rhythm regularity could be assessed in 98.7{\%} of ECGs recorded. 92 patients (5.1{\%}) were found to have AF. Median [range]CHA2DS2-VASc score was 4 ([2-7) and median [range] HAS-BLED score was 2 (1-5).CONCLUSION: handheld ECG recording can be used to identify AF in the primary care setting, with minimal training. The yield was relatively high.",
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    author = "Grubb, {Neil R} and Douglas Elder and Paul Broadhurst and Anne Reoch and Emma Tassie and Aileen Neilson",
    note = "Crown Copyright {\circledC} 2019. Published by Elsevier B.V. All rights reserved. This work was funded by the Scottish Government via the National Advisory Committee for Stroke and the National Advisory Committee for Heart Disease. There was no grant ID associated with this funding.",
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    Atrial fibrillation case finding in over 65 s with cardiovascular risk factors : Results of initial Scottish clinical experience. / Grubb, Neil R (Lead / Corresponding author); Elder, Douglas; Broadhurst, Paul; Reoch, Anne; Tassie, Emma; Neilson, Aileen.

    In: International journal of cardiology, Vol. 288, 01.08.2019, p. 94-99.

    Research output: Contribution to journalArticle

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    T2 - Results of initial Scottish clinical experience

    AU - Grubb, Neil R

    AU - Elder, Douglas

    AU - Broadhurst, Paul

    AU - Reoch, Anne

    AU - Tassie, Emma

    AU - Neilson, Aileen

    N1 - Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved. This work was funded by the Scottish Government via the National Advisory Committee for Stroke and the National Advisory Committee for Heart Disease. There was no grant ID associated with this funding.

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    N2 - BACKGROUND: Atrial fibrillation (AF) is a major preventable risk factor for stroke and may be silent in elderly individuals who are at especially high risk. This paper describes the first phase of implementation of a clinical AF detection programme in a community setting. Objectives were (i) to determine the feasibility of using a handheld ECG recording system for AF detection among individuals aged 65 years or more, who have cardiovascular risk factors. (ii) to estimate the yield of previously undiagnosed atrial fibrillation cases, and the proportion of these who would be suitable for oral anticoagulation.METHODS: a handheld ECG monitor was placed in each of 23 primary care practices across Scotland. Eligible patients attending for annual health checks had ECGs recorded, and the ECGs were transmitted and interpreted by two senior cardiologists. ECG quality was rated, and an adjudication made on the rhythm. For patients confirmed with AF, stroke and bleeding risk were estimated using CHA2DS2-VASc and HAS-BLED scoring tools.RESULTS: single lead ECGs were recorded in 1805 patients (703 female and 1102 male), mean (SD) age 74.9 (7.1) years. Rhythm regularity could be assessed in 98.7% of ECGs recorded. 92 patients (5.1%) were found to have AF. Median [range]CHA2DS2-VASc score was 4 ([2-7) and median [range] HAS-BLED score was 2 (1-5).CONCLUSION: handheld ECG recording can be used to identify AF in the primary care setting, with minimal training. The yield was relatively high.

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