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The feasibility of population screening for paroxysmal atrial fibrillation using handheld ECGs.

Authors
  • Mant, Jonathan
  • Modi, Rakesh N
  • Charlton, Peter
  • Dymond, Andrew
  • Massou, Efthalia
  • Brimicombe, James
  • Freedman, Ben
  • Griffin, Simon J
  • Hobbs, FD Richard
  • Lip, Gregory YH
  • McManus, Richard J
  • Williams, Kate
Publication Date
Feb 27, 2024
Source
Apollo - University of Cambridge Repository
Keywords
Language
English
License
Green
External links

Abstract

BACKGROUND AND AIMS: There are few data on the feasibility of population screening for paroxysmal AF using hand-held 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: 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 (3 practices). Participants were asked to use a handheld ECG for 1-4 weeks. Screening outcomes included: uptake, quality of ECGs, AF detection rates, and uptake of anticoagulation if AF was detected. RESULTS: Screening was carried out by 2,141 (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% (64/2,429) screened participants had AF, with detection rising with age (9.2% in people aged 85 or over). 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, and in all ages over 64 years, including in people aged 85 and over. / The SAFER feasibility study was funded by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0217-20007) and by the NIHR School for Primary Care Research (SPCR-2014-10043, project 410). SAFER is a contributor to/partner of AFFECT-EU in receipt of funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no 847770. RNM’s contribution was supported by the Wellcome Trust as part of the Wellcome Trust PhD Programme for Primary Care Clinicians (grant number 203921/Z/16/Z). PHC was supported by a British Heart Foundation grant (grant number FS/20/20/34626). FDRH acknowledges support form NIHR ARC OTV and Oxford BRC (OU). RJM is an NIHR Senior Investigator and acknowledges support from NIHR ARC OTV. The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. BF received a New South Wales Health Senior Researcher Cardiovascular Grant for work in AF. GYHL is a NIHR Senior Investigator and co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 899871.

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