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Almroth H, Karlsson LO, Carlhäll CJ, Charitakis E. Haemodynamic changes after atrial fibrillation initiation in patients eligible for catheter ablation: a randomized controlled study. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead112. [PMID: 38025650 PMCID: PMC10655843 DOI: 10.1093/ehjopen/oead112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/11/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023]
Abstract
Aims Atrial fibrillation (AF) haemodynamics is less well studied due to challenges explained by the nature of AF. Until now, no randomized data are available. This study evaluates haemodynamic variables after AF induction in a randomized setting. Methods and results Forty-two patients with AF who had been referred for ablation to the University Hospital, Linköping, Sweden, and had no arrhythmias during the 4-day screening period were randomized to AF induction vs. control (2:1). Atrial fibrillation was induced by burst pacing after baseline intracardiac pressure measurements. Pressure changes in the right and left atrium (RA and LA), right ventricle (RV), and systolic and diastolic blood pressures (SBP and DBP) were evaluated 30 min after AF induction compared with the control group. A total of 11 women and 31 men (median age 60) with similar baseline characteristics were included (intervention n = 27, control group n = 15). After 30 min in AF, the RV end-diastolic pressure (RVEDP) and RV systolic pressure (RVSP) significantly reduced compared with baseline and between randomization groups (RVEDP: P = 0.016; RVSP: P = 0.001). Atrial fibrillation induction increased DBP in the intervention group compared with the control group (P = 0.02), unlike reactions in SBP (P = 0.178). Right atrium and LA mean pressure (RAm and LAm) responses did not differ significantly between the groups (RAm: P = 0.307; LAm: P = 0.784). Conclusion Induced AF increased DBP and decreased RVEDP and RVSP. Our results allow us to understand some paroxysmal AF haemodynamics, which provides a haemodynamic rationale to support rhythm regulatory strategies to improve symptoms and outcomes. Trial registration number clinicaltrialsgov No NCT01553045. https://clinicaltrials.gov/ct2/show/NCT01553045?term=NCT01553045&rank=1.
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Affiliation(s)
- Henrik Almroth
- Department of Cardiology, Linköping University Hospital, Garnisonsvägen 10, 581 85 Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Garnisonsvägen 10, 581 85 Linköping, Sweden
| | - Lars O Karlsson
- Department of Cardiology, Linköping University Hospital, Garnisonsvägen 10, 581 85 Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Garnisonsvägen 10, 581 85 Linköping, Sweden
| | - Carl-Johan Carlhäll
- Department of Health, Medicine and Caring Sciences, Linköping University, Garnisonsvägen 10, 581 85 Linköping, Sweden
- Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden
| | - Emmanouil Charitakis
- Department of Cardiology, Linköping University Hospital, Garnisonsvägen 10, 581 85 Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Garnisonsvägen 10, 581 85 Linköping, Sweden
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2
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Fadlan MR, Rizal A, Satrijo B, Astiawati T, Rohman MS, Baskoro SS. Validity of MENARI plus (self-pulse assessment and clinical scoring) mobile apps for detecting atrial fibrillation in high-risk population. J Arrhythm 2023; 39:507-514. [PMID: 37560267 PMCID: PMC10407179 DOI: 10.1002/joa3.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 03/07/2023] [Accepted: 04/08/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Even before it is clinically diagnosed, atrial fibrillation (AF) can cause a stroke. This study validates self-pulse assessment and clinical scoring (MENARI Plus) based on android apps. OBJECTIVE The aim of this study was to examine the validity of AF screening using MENARI Plus compared with an ECG recording. METHODS We collected a total of 1385 subjects from high-risk population according to CHA2DS2-VASc score ≥2, attending 8 primary care centers (PCCs) in Malang between July 2021 and December 2021. Every participant underwent self-pulse assessment, and then was evaluated for MENARI Plus Score on android Apps. These cases had been classified as low or high probability for AF (cut-off score 7). After that, electrocardiography examinations were performed and classified with AF and Sinus Rhythm group. RESULTS In this study, the mean age of these patients was 61.5 ± 6.9 years old. We found that 156/1385 (11%) patients had AF. There were 68/156 (43.5%) new cases of AF. The sensitivity for self-pulse palpation was 73.1% (95% CI: 68%-76%) and specificity was 68.3% (95% CI: 65%-72%). MENARI Plus had an area under the receiver operating curve (AUC) of 0.86 (95% CI: 0.82-0.89) with sensitivity per measurement occasion was (84%, 95% CI: 82%-88%) and specificity was (87.9%, 95% CI: 82%-90%). CONCLUSION In this study, we found that MENARI Plus has high sensitivity and specificity for AF. It is therefore useful for ruling out AF. It may also be a useful screen that can be applied opportunistically for previously undetected AFs.
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Affiliation(s)
- Muhamad R. Fadlan
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Ardian Rizal
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Budi Satrijo
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Tri Astiawati
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Iskak General HospitalTulung AgungEast JavaIndonesia
| | - Mohammad S. Rohman
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Shalahuddin S. Baskoro
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
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3
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Halahakone U, Senanayake S, McCreanor V, Parsonage W, Kularatna S, Brain D. Cost-Effectiveness of Screening to Identify Patients With Atrial Fibrillation: A Systematic Review. Heart Lung Circ 2023:S1443-9506(23)00152-X. [PMID: 37100697 DOI: 10.1016/j.hlc.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Screening for Atrial Fibrillation (AF) is recommended for people aged above 65 years. Screening for AF in asymptomatic individuals can be beneficial by enabling earlier diagnosis and the commencement of interventions to reduce the risk of early events, thus improving patient outcomes. This study systematically reviews the literature about the cost-effectiveness of various screening methods for previously undiagnosed AF. METHODS Four databases were searched to identify articles that are cost-effectiveness studies conducted on screening for AF published from January 2000 to August 2022. The Consolidated Health Economic Evaluation Reporting Standards 2022 checklist was used to assess the quality of the selected studies. A previously published approach was used to assess the usefulness of each study for health policy makers. RESULTS The database search yielded 799 results, with 26 articles meeting the inclusion criteria. Articles were categorised into four subgroups: (i) population screening, (ii) opportunistic screening, (iii) targeted, and (iv) mixed methods of screening. Most of the studies screened adults ≥65 years of age. Most studies were performed from a 'health care payer perspective' and almost all studies used 'not screening' as a comparator. Almost all screening methods assessed were found to be cost-effective in comparison to 'not screening'. The reporting quality varied between 58% to 89%. The majority of the studies were found to be of limited usefulness for health policy makers, as none of the studies made any clear statements about policy change or implementation direction. CONCLUSION All approaches of AF screening were found to be cost-effective compared with no screening, while opportunistic screening was found to be the optimal approach in some studies. However, screening for AF in asymptomatic individuals is context specific and likely to be cost-effective depending on the population screened, screening approach, frequency, and the duration of screening.
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Affiliation(s)
- Ureni Halahakone
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia.
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia
| | - Victoria McCreanor
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia; Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Metro North Health, Brisbane, Qld, Australia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia; Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Qld, Australia; Digital Health and Informatics Directorate, Metro South Health, Brisbane, Qld, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia
| | - David Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia
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4
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Kalarus Z, Mairesse GH, Sokal A, Boriani G, Średniawa B, Casado-Arroyo R, Wachter R, Frommeyer G, Traykov V, Dagres N, Lip GYH, Boersma L, Peichl P, Dobrev D, Bulava A, Blomström-Lundqvist C, de Groot NMS, Schnabel R, Heinzel F, Van Gelder IC, Carbuccichio C, Shah D, Eckardt L. Searching for atrial fibrillation: looking harder, looking longer, and in increasingly sophisticated ways. An EHRA position paper. Europace 2023; 25:185-198. [PMID: 36256580 PMCID: PMC10112840 DOI: 10.1093/europace/euac144] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zbigniew Kalarus
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Georges H Mairesse
- Department of Cardiology and Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, Arlon, Belgium
| | - Adam Sokal
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Beata Średniawa
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Münster, Germany
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lucas Boersma
- Department of Cardiology, St Antonius Hospital,, Utrecht, The Netherlands.,Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Petr Peichl
- Klinika Kardiologie, IKEM, Prague, Czech Republic
| | - Dobromir Dobrev
- Faculty of Medicine, Institute of Pharmacology, University Duisburg-Essen, Essen, Germany
| | - Alan Bulava
- Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Czech Republic and Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic
| | | | - Natasja M S de Groot
- Department of Cardiology-Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Renate Schnabel
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Frank Heinzel
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Isabelle C Van Gelder
- Department Of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Dipen Shah
- Department of Cardiology, Cantonal Hospital, CH-1211 Geneva, Switzerland
| | - Lars Eckardt
- University Clinic of Munster (Ukm), Munster, Germany
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5
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Fabritz L, Connolly DL, Czarnecki E, Dudek D, Guasch E, Haase D, Huebner T, Zlahoda-Huzior A, Jolly K, Kirchhof P, Obergassel J, Schotten U, Vettorazzi E, Winkelmann SJ, Zapf A, Schnabel RB. Smartphone and wearable detected atrial arrhythmias in Older Adults: Results of a fully digital European Case finding study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:610-625. [PMID: 36710894 PMCID: PMC9779806 DOI: 10.1093/ehjdh/ztac067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/24/2022] [Indexed: 11/23/2022]
Abstract
Aims Simplified detection of atrial arrhythmias via consumer-electronics would enable earlier therapy in at-risk populations. Whether this is feasible and effective in older populations is not known. Methods and results The fully remote, investigator-initiated Smartphone and wearable detected atrial arrhythmia in Older Adults Case finding study (Smart in OAC-AFNET 9) digitally enrolled participants ≥65 years without known atrial fibrillation, not receiving oral anticoagulation in Germany, Poland, and Spain for 8 weeks. Participants were invited by media communications and direct contacts. Study procedures adhered to European data protection. Consenting participants received a wristband with a photoplethysmography sensor to be coupled to their smartphone. The primary outcome was the detection of atrial arrhythmias lasting 6 min or longer in the first 4 weeks of monitoring. Eight hundred and eighty-two older persons (age 71 ± 5 years, range 65-90, 500 (57%) women, 414 (47%) hypertension, and 97 (11%) diabetes) recorded signals. Most participants (72%) responded to adverts or word of mouth, leaflets (11%) or general practitioners (9%). Participation was completely remote in 469/882 persons (53%). During the first 4 weeks, participants transmitted PPG signals for 533/696 h (77% of the maximum possible time). Atrial arrhythmias were detected in 44 participants (5%) within 28 days, and in 53 (6%) within 8 weeks. Detection was highest in the first monitoring week [incidence rates: 1st week: 3.4% (95% confidence interval 2.4-4.9); 2nd-4th week: 0.55% (0.33-0.93)]. Conclusion Remote, digitally supported consumer-electronics-based screening is feasible in older European adults and identifies atrial arrhythmias in 5% of participants within 4 weeks of monitoring (NCT04579159).
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Affiliation(s)
- L Fabritz
- Corresponding author. Tel. +4940741057980,
| | - D L Connolly
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston Wolfson Drive, B15 2TT Birmingham, UK,Department of Cardiology and R&D, Birmingham City Hospital, Sandwell and West Birmingham Trust, Dudley Road, B18 7QH Birmingham, UK
| | - E Czarnecki
- Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | - D Dudek
- Jagiellonian University Medical College, Center for Digital Medicine and Robotics, Ul. Kopernika 7E, 33-332 Kraków, Poland,Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola RA, Italy
| | - E Guasch
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Carrer de Villaroel, 170, 08036 Barcelona, CA, Spain, Spain,IDIBAPS, Rosselló 149-153, 08036 Barcelona, CA, Spain,CIBERCV, Monforte de Lemos 3-5, Pabellon 11, Planta 0, 28029 Madrid, Spain
| | - D Haase
- Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | - T Huebner
- Preventicus GmbH, Ernst-Abbe-Straße 15, 07743 Jena, Germany
| | - A Zlahoda-Huzior
- Department of Measurement and Electronics, AGH University of Science and Technology, Al. Mickiewicza 30, 30-059 Kraków, Poland
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT Birmingham, UK
| | - P Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany,DZHK German Center for Cardiovascular Research, partner site Hamburg/Luebeck/Kiel, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston Wolfson Drive, B15 2TT Birmingham, UK,Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
| | - J Obergassel
- University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany,DZHK German Center for Cardiovascular Research, partner site Hamburg/Luebeck/Kiel, Germany
| | - U Schotten
- Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany,Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center +, Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - E Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Christoph-Probst-Weg 1, 20246 Hamburg, Germany
| | - S J Winkelmann
- University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany
| | - A Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Christoph-Probst-Weg 1, 20246 Hamburg, Germany
| | - R B Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251 Hamburg, Germany,DZHK German Center for Cardiovascular Research, partner site Hamburg/Luebeck/Kiel, Germany,Atrial Fibrillation NETwork (AFNET), Mendelstr 11, 48149 Münster, Germany
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6
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Zhou CB, Hu YG, Fan YN, Wu N, Yao CY, Liu XL, Zhou YM, Xiao H, Tang EJ, Li DW, Cai TJ, Ji AL. More obvious association between short-term ambient nitrogen dioxide and atrial fibrillation outpatient visits in cool seasons: A hospital-based study in northwestern China. ENVIRONMENTAL RESEARCH 2022; 212:113220. [PMID: 35398083 DOI: 10.1016/j.envres.2022.113220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/12/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
Atrial fibrillation (AF) is the most common sustained heart rhythm disorder associated with high mortality and morbidity. Limited studies have been conducted to assess the relationship between short-term exposure to ambient air pollution and AF attacks. This study aimed to explore the association between short-term ambient nitrogen dioxide (NO2) exposure and outpatient visits for AF in Xi'an, China. Data on daily AF outpatient visits and air pollutants from 2013 to 2019 (2555 days) were obtained. A time-series approach using over-dispersed Poisson generalized additive model (GAM) was employed, and stratified analyses were performed to investigate the potential modifying effects by season, age, and gender. A total of 8307 outpatient visits for AF were recorded. Increased levels of NO2 were associated with increased AF outpatient visits, and the most significant effect estimates were observed at lag 03: A 10 μg/m3 increase of NO2 at lag 03 was related to an elevation of 5.59% (95% CI: 2.67%, 8.51%) in daily outpatient visits for AF. Stratified analyses showed that there were no gender and age difference in the effect of NO2, while more obvious association was observed in cool seasons (October to March) than in warm seasons (April to September). In summary, short-term ambient NO2 exposure can be positively associated with daily outpatient visits for AF, especially in cool seasons. This work provided novel data that the association between air pollutants and AF can vary by seasons, further supporting that the prevention of cardiovascular health effects should be strengthened in winter.
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Affiliation(s)
- Chun-Bei Zhou
- Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China; Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Yue-Gu Hu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Yan-Ni Fan
- Medical Record Room of Information Department, Second Affiliated Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710038, China
| | - Na Wu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Chun-Yan Yao
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Xiao-Ling Liu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Yu-Meng Zhou
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Hua Xiao
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - En-Jie Tang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Da-Wei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Tong-Jian Cai
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
| | - Ai-Ling Ji
- Department of Preventive Medicine, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, China.
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7
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Ghazal F, Aronsson M, Al-Khalili F, Rosenqvist M, Levin LÅ. Cost-effectiveness of screening for atrial fibrillation in a single primary care center at a 3-year follow-up. SCAND CARDIOVASC J 2022; 56:35-41. [PMID: 35389311 DOI: 10.1080/14017431.2022.2060523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the cost-effectiveness of intermittent electrocardiogram (ECG) screening for atrial fibrillation (AF) among 70-74-year old individuals in primary care. We also aimed to assess adherence to anticoagulants, severe bleeding, stroke and mortality among screening-detected AF cases at three-year follow-up. METHODS A post hoc analysis based on a cross-sectional screening study for AF among 70-74-year old patients, who were registered at a single primary care center, was followed for three years for mortality. Data about adherence to anticoagulants, incidence of stroke and severe bleeding among screening-detected AF cases, were collected from patient's records. Markov model and Monte Carlo simulation were used to assess the cost-effectiveness of the screening program. RESULTS The mortality rate among screening-detected AF cases (n = 16) did not differ compared to the 274 individuals with no AF (hazard ratio 0.86, CI 0.12-6.44). Adherence to anticoagulants was 92%. There was no stroke or severe bleeding. The incremental cost-effectiveness ratio of screening versus no screening was EUR 2389/quality-adjusted life year (QALY) gained. The screening showed a 99% probability of being cost-effective compared to no screening at a willingness-to-pay threshold of EUR 20,000 per QALY. CONCLUSION Screening for AF among 70-74-year olds in primary care using intermittent ECG appears to be cost-effective at 3-year follow-up with high anticoagulants adherence and no increased mortality.
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Affiliation(s)
- Faris Ghazal
- Department of Clinical Science, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Aronsson
- Department of Health Care Analysis and Department of Medical and Health Sciences, Linkopings Universitet, Linkoping, Sweden.,AstraZeneca, Sodertalje, Sweden
| | - Faris Al-Khalili
- Department of Clinical Science, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mårten Rosenqvist
- Department of Clinical Science, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Åke Levin
- Department of Health Care Analysis and Department of Medical and Health Sciences, Linkopings Universitet, Linkoping, Sweden
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8
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Engdahl J, Rosenqvist M. Large-scale screening studies for atrial fibrillation - is it worth the effort? J Intern Med 2021; 289:474-492. [PMID: 33411987 PMCID: PMC8048511 DOI: 10.1111/joim.13217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF) is a common disease with increasing prevalence, approximately 3.2% in the adult population. In addition, about one third of AF cases are considered asymptomatic. Due to increased longevity, increased detection and increased prevalence of risk factors, the prevalence of AF is expected to at least double by the year 2060. Patients with AF have an increased risk for ischaemic stroke, heart failure, death and cognitive decline. Treatment with oral anticoagulation reduces the risk of ischaemic stroke and mortality, and the effect on cognitive decline is being studied. Based on the increasing prevalence of AF, its often asymptomatic and paroxysmal presentation and the efficacy of oral anticoagulation treatment, screening for AF has been proposed. AF seems to fulfil most of the Wilson-Jungner criteria for screening issued by the World Health Organization, but some knowledge gaps remain, gaps that will be addressed by several ongoing studies. The knowledge gaps in AF screening consist of the magnitude of the net benefit or net harm inflicted by AF screening because the oral anticoagulation treatment will also increase the risk of bleeding, and the psychological effects of AF screening are not very well studied. So far, the AF screening recommendations issued by the European Society of Cardiology have had limited impact on national and regional AF screening activities. Several large-scale AF screening studies will report results on hard endpoints within the next few years, and these results will hopefully manifest AF as a cardiovascular disease which we need to pay more attention to.
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Affiliation(s)
- J Engdahl
- From the, Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
| | - M Rosenqvist
- From the, Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
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9
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Gudmundsdottir KK, Fredriksson T, Svennberg E, Al-Khalili F, Friberg L, Häbel H, Frykman V, Engdahl J. Performance of pulse palpation compared to one-lead ECG in atrial fibrillation screening. Clin Cardiol 2021; 44:692-698. [PMID: 33724492 PMCID: PMC8119837 DOI: 10.1002/clc.23595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/12/2022] Open
Abstract
Background The 2020 European Society of Cardiology atrial fibrillation guidelines recommend opportunistic screening for atrial fibrillation by pulse taking or ECG rhythm strip in those aged over 65 years. Hypothesis We aimed to compare the diagnostic accuracy of pulse palpation to ECG rhythm strip when screening for atrial fibrillation. A secondary aim was to investigate whether participants with palpitations were more likely to be diagnosed with new atrial fibrillation. Methods The study population were 75/76 year old individuals that participated in the STROKESTOP II study, a Swedish screening study for atrial fibrillation. Pulse palpation of the radial pulse for 30 sec was performed by healthcare professionals and recorded as regular or irregular. Thereafter a 30‐sec single‐lead ECG was registered. Patients were asked also if they had a history of palpitations. Results Of the 6159 participants included in the study, 461 (7.5%) had irregular pulse. Twenty‐two (4.8%) of those with irregular pulse were diagnosed with atrial fibrillation on single‐lead ECG rhythm strip. Among those with regular pulse, 6 (0.1%) cases of new atrial fibrillation were found. The sensitivity of the pulse palpation test was 78.6% and positive predictive value 4.8%. The proportion of newly diagnosed atrial fibrillation was not different between those with and without history of palpitations. Conclusion Pulse palpation was inferior to single‐lead ECG when screening for atrial fibrillation. We therefore advocate the use of single‐lead ECG rather than pulse palpation when screening for atrial fibrillation. Palpitations did not predict atrial fibrillation.
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Affiliation(s)
| | - Tove Fredriksson
- Karolinska Institutet, Dept. of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Emma Svennberg
- Karolinska Institutet, Dept. of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Faris Al-Khalili
- Karolinska Institutet, Dept. of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Leif Friberg
- Karolinska Institutet, Dept. of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Henrike Häbel
- Karolinska Institutet, Division of Biostatistics, Institute of Environmental Medicine, Stockholm, Sweden
| | - Viveka Frykman
- Karolinska Institutet, Dept. of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Johan Engdahl
- Karolinska Institutet, Dept. of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
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Atrial fibrillation prevalence and risk profile from novel community-based screening in Thailand: A prospective multi-centre study. IJC HEART & VASCULATURE 2021; 32:100709. [PMID: 33490362 PMCID: PMC7811109 DOI: 10.1016/j.ijcha.2020.100709] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 02/04/2023]
Abstract
Background In Thailand, almost one-quarter of strokes are related to atrial fibrillation (AF), and many could be prevented if AF were diagnosed and treated prior to the stroke. Therefore, we tested a novel strategy to screen large numbers of community residents using village health volunteers and primary care nurses. Methods Local primary care nurses and village health volunteers in Phetchaburi and Lopburi provinces, Thailand were trained to perform AF screening using a blood pressure device with AF algorithm (Microlife A200 AFib). 10% of residents aged ≥ 65 years were randomly selected for screening during home-visits. Participants with possible AF were given follow-up appointments for further testing, including 12-lead ECG and echocardiogram. Results Over two-months, 9.7% (13,864/143,478) of the target population were screened: mean age 73.2 ± 6.4 years, 32.4% male. The estimated AF prevalence (detected by Microlife A200 AFib) was 2.8% (95% CI, 2.6-3.1%) for age ≥ 65 years (i.e. 393/13,864 participants). Prevalence increased with age from 1.9% (65-69 years) to 5.0% (≥85 years) (p < 0.001). Only 58% (226/393) of participants with suspected AF attended the follow-up appointment (1-3 months after initial screen): mean CHA2DS2-VASc score 3.2 ± 1.2; 86.3% (195/226) had Class-1 oral anticoagulation recommendation, and 33% (75/226) had AF on 12-lead ECG. Conclusions In Thailand, large-scale AF screening in the community is feasible using trained volunteer health workers, allowing screening of large numbers in a short time-period. Further investigation of this strategy is warranted, ensuring mechanisms to obtain a timely rhythm strip or 12-lead ECG locally, and a designated pathway to treatment.
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11
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Savickas V, Stewart AJ, Rees-Roberts M, Short V, Bhamra SK, Corlett SA, Mathie A, Veale EL. Opportunistic screening for atrial fibrillation by clinical pharmacists in UK general practice during the influenza vaccination season: A cross-sectional feasibility study. PLoS Med 2020; 17:e1003197. [PMID: 32678820 PMCID: PMC7367445 DOI: 10.1371/journal.pmed.1003197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Growing prevalence of atrial fibrillation (AF) in the ageing population and its associated life-changing health and resource implications have led to a need to improve its early detection. Primary care is an ideal place to screen for AF; however, this is limited by shortages in general practitioner (GP) resources. Recent increases in the number of clinical pharmacists within primary care makes them ideally placed to conduct AF screening. This study aimed to determine the feasibility of GP practice-based clinical pharmacists to screen the over-65s for AF, using digital technology and pulse palpation during the influenza vaccination season. METHODS AND FINDINGS Screening was conducted over two influenza vaccination seasons, 2017-2018 and 2018-2019, in four GP practices in Kent, United Kingdom. Pharmacists were trained by a cardiologist to pulse palpate, record, and interpret a single-lead ECG (SLECG). Eligible persons aged ≥65 years (y) attending an influenza vaccination clinic were offered a free heart rhythm check. Six hundred four participants were screened (median age 73 y, 42.7% male). Total prevalence of AF was 4.3%. All participants with AF qualified for anticoagulation and were more likely to be male (57.7%); be older; have an increased body mass index (BMI); and have a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, previous Stroke, Vascular disease, Age 65-74 years, Sex category) score ≥ 3. The sensitivity and specificity of clinical pharmacists diagnosing AF using pulse palpation was 76.9% (95% confidence interval [CI] 56.4-91.0) and 92.2% (95% CI 89.7-94.3), respectively. This rose to 88.5% (95% CI 69.9-97.6) and 97.2% (95% CI 95.5-98.4) with an SLECG. At follow-up, four participants (0.7%) were diagnosed with new AF and three (0.5%) were initiated on anticoagulation. Screening with SLECG also helped identify new non-AF cardiovascular diagnoses, such as left ventricular hypertrophy, in 28 participants (4.6%). The screening strategy was cost-effective in 71.8% and 64.3% of the estimates for SLECG or pulse palpation, respectively. Feedback from participants (422/604) was generally positive. Key limitations of the study were that the intervention did not reach individuals who did not attend the practice for an influenza vaccination and there was a limited representation of UK ethnic minority groups in the study cohort. CONCLUSIONS This study demonstrates that AF screening performed by GP practice-based pharmacists was feasible, economically viable, and positively endorsed by participants. Furthermore, diagnosis of AF by the clinical pharmacist using an SLECG was more sensitive and more specific than the use of pulse palpation alone. Future research should explore the key barriers preventing the adoption of national screening programmes.
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Affiliation(s)
- Vilius Savickas
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Adrian J. Stewart
- Medway Maritime Hospital, Cardiology, Gillingham, Kent, United Kingdom
| | - Melanie Rees-Roberts
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Vanessa Short
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
- Newton Place Surgery, Faversham, United Kingdom
| | - Sukvinder K. Bhamra
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Sarah A. Corlett
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Alistair Mathie
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
| | - Emma L. Veale
- Medway School of Pharmacy, University of Kent and University of Greenwich, Chatham Maritime, Kent, United Kingdom
- * E-mail:
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