Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population

Tijn Hendrikx, Rolf Hörnsten, Mårten Rosenqvist, Herbert Sandström, Tijn Hendrikx, Rolf Hörnsten, Mårten Rosenqvist, Herbert Sandström

Abstract

Background: the objective of this study is to investigate the detection rate of undiagnosed atrial fibrillation (AF) with short intermittent ECG recordings during four weeks among out-of-hospital patients, having at least one additional risk factor (CHADS2) for stroke.

Design: Cross-sectional study.

Setting: Eight family practice centres and two hospital-based out-patient clinics in Sweden.

Subjects: 989 out-of-hospital patients, without known AF, having one or more risk factors associated with stroke (CHADS2).

Interventions: All individuals were asked to perform 10-second handheld ECG recordings during 28 days, twice daily and when having palpitations.

Main outcome measures: Episodes of AF on handheld ECG recordings were defined as irregular supraventricular extrasystoles in series with a duration of 10 seconds.

Results: 928 patients completed registration. AF was found in 35 of 928 patients; 3.8% (95% confidence interval [CI] 2.7-5.2). These 35 patients had a mean age of 70.7 years (SD ± 7.7; range 53-85) and a median CHADS2 of 2 (range 1-4).

Conclusions: Intermittent handheld ECG recording over a four week period had a detection rate of 3.8% newly diagnosed AF, in a population of 928 out-of-hospital patients having at least one additional risk factor for stroke. Intermittent handheld ECG registration is a feasible method to detect AF in patients with an increased risk of stroke in whom oral anticoagulation (OAC) treatment is indicated.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Example of registration of AF with handheld ECG.
Figure 3
Figure 3
Photo of the handheld ECG device.
Figure 4
Figure 4
Time from inclusion until AF detection.

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