Atrial fibrillation case finding in over 65 s with cardiovascular risk factors – Results of initial Scottish clinical experience

Neil R. Grubb* (Corresponding Author), Douglas Elder, Paul Broadhurst, Anne Reoch, Emma Tassie, Aileen Neilson

*Corresponding author for this work

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 CHA 2 DS 2 -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]CHA 2 DS 2 -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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Atrial fibrillation case finding in over 65 s with cardiovascular risk factors – Results of initial Scottish clinical experience. / Grubb, Neil R. (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

@article{4fd50065994b4768b8e65ee48bb82547,
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 CHA 2 DS 2 -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]CHA 2 DS 2 -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.",
keywords = "Ambulatory monitoring, Atrial fibrillation, Public health, Screening, Stroke, Telehealth",
author = "Grubb, {Neil R.} and Douglas Elder and Paul Broadhurst and Anne Reoch and Emma Tassie and Aileen Neilson",
note = "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.",
year = "2019",
month = "8",
day = "1",
doi = "10.1016/j.ijcard.2019.03.062",
language = "English",
volume = "288",
pages = "94--99",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Atrial fibrillation case finding in over 65 s with cardiovascular risk factors – 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 - 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.

PY - 2019/8/1

Y1 - 2019/8/1

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 CHA 2 DS 2 -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]CHA 2 DS 2 -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.

AB - 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 CHA 2 DS 2 -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]CHA 2 DS 2 -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.

KW - Ambulatory monitoring

KW - Atrial fibrillation

KW - Public health

KW - Screening

KW - Stroke

KW - Telehealth

UR - http://www.scopus.com/inward/record.url?scp=85064820796&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2019.03.062

DO - 10.1016/j.ijcard.2019.03.062

M3 - Article

VL - 288

SP - 94

EP - 99

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -