The feasibility of population screening for paroxysmal atrial fibrillation using hand-held electrocardiogram devices.
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Abstract
AIMS: There are few data on the feasibility of population screening for paroxysmal atrial fibrillation (AF) using hand-held electrocardiogram (ECG) devices outside a specialist setting or in people over the age of 75. We investigated the feasibility of screening when conducted without face-to-face contact ('remote') or via in-person appointments in primary care and explored impact of age on screening outcomes. METHODS AND RESULTS: People aged ≥65 years from 13 general practices in England participated in screening during 2019-20. This involved attending a practice nurse appointment (10 practices) or receiving an ECG device by post (three practices). Participants were asked to use a hand-held ECG for 1-4 weeks. Screening outcomes included uptake, quality of ECGs, AF detection rates, and uptake of anticoagulation if AF was detected. Screening was carried out by 2141 (87.5%) of people invited to practice nurse-led screening and by 288 (90.0%) invited to remote screening. At least 56 interpretable ECGs were provided by 98.0% of participants who participated for 3 weeks, with no significant differences by setting or age, except people aged 85 or over (91.1%). Overall, 2.6% (64/2429) screened participants had AF, with detection rising with age (9.2% in people aged 85 or over). A total of 53/64 (82.8%) people with AF commenced anticoagulation. Uptake of anticoagulation did not vary by age. CONCLUSION: Population screening for paroxysmal AF is feasible in general practice and without face-to-face contact for all ages over 64 years, including people aged 85 and over.
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Funder: National Institute for Health and Care Research; DOI: https://doi.org/10.13039/501100000272
Funder: AFFECTEU
Funder: Wellcome Trust; DOI: https://doi.org/10.13039/100010269
Funder: ARC; DOI: https://doi.org/10.13039/100000163
Funder: OTV
Funder: Oxford BRC
Funder: NHS; DOI: https://doi.org/10.13039/100030827
Funder: New South Wales Health Senior Researcher Cardiovascular Grant
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1532-2092
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National Institute for Health Research (NIHR) (via Cambridgeshire and Peterborough Clinical Commissioning Group (CCG)) (PGfAR RP-PG-0217-20007)
European Commission Horizon 2020 (H2020) ERC (847770)