Review of Screening Studies for Atrial Fibrillation in Rural Populations of 11 Countries

Abstract

Atrial fibrillation (AF) is a common cardiac arrhythmia, and pathological burden can be influenced by environmental factors. The rural environment may influence the burden of AF, although no systematic review studies have been conducted to address this issue. We performed a systematic review of AF screening studies conducted in rural global populations to determine the burden, risk factors, and screening methods surrounding AF in these settings. Out of the 1792 articles gathered from a keyword search of medical databases and reference lists, 18 publications from 11 countries were included in our analysis. The pooled prevalence of AF across the studies was 2.05% (95% confidence interval, 1.97%-2.13%) and ranged from 0.3% to 10.87%. Only one study utilized a handheld electrocardiogram to screen AF, while the rest used the 12-lead electrocardiogram. AF risk factors reported across studies varied and included increasing age, male gender, hypertension, diabetes, prior myocardial infarction or stroke, obesity, hyperlipidemia/hypercholesterolemia, alcohol consumption, and heart failure. However, none of the studies assessed all risk factors. We suggest that future research on AF in rural communities examine a complete checklist of AF risk factors to better understand their influence on AF burden and development. This will aid in understanding rural prevention strategies and the management of detected AF cases specific to rural areas. At present, the burden of AF in rural communities is poorly understood and has been underreported.

Incremental yield of ECG screening repeated annually over 4 years in an adult Japanese population without prior atrial fibrillation: a retrospective cohort study

“…It is well established that significant racial differences exist, and rates of AF in Japan are much lower across all age groups, compared with representative data reported from Western countries. 12 13 It is therefore not surprising that the incidence rate of new AF for people aged ≥65 years is also lower in our study (~0.45%/year) than the rate of 1.4% in Western Countries, identified in a systematic review of screening. 14 It is thought that lower AF rates in Japan may be related to overall lower incidences of cardio-metabolic and other risk factors for AF, but over the next few decades, AF prevalence may increase with a gradual increase in lifestyle-related cardio-metabolic risk factors.…”

“… 14 It is thought that lower AF rates in Japan may be related to overall lower incidences of cardio-metabolic and other risk factors for AF, but over the next few decades, AF prevalence may increase with a gradual increase in lifestyle-related cardio-metabolic risk factors. 12 13 Therefore, the incidence of new AF in Japan may escalate in the future and will benefit from early detection. However, it is likely that many cases would not be detected without annual screening, as the majority (~73%) of our new AF cases were asymptomatic.…”

Left Atrial Size Contribution to the Predictive Capacity of Two Scores for Atrial Fibrillation in the Postoperative Period of Cardiac Surgeries

“…Patients with POAF were older compared to those who did not develop arrhythmia. Advanced age is, admittedly, a major risk factor for AF in patients in general 16,17 and in those undergoing cardiac surgery. 18,19 In fact, population aging, especially in emerging countries, will play an important role in changing the incidence of this type of arrhythmia in the general population, as well as in patients undergoing cardiac surgery.…”

Atrial Fibrillation Screen, Management And Guideline Recommended Therapy (AF SMART II) in the rural primary care setting: an implementation study protocol

“…A recent systematic review of AF screening studies conducted in rural settings acknowledged the need for more information on AF burden and risk factors specifically in rural areas. 27 In the Australian context, it is known that people living in rural areas have worse cardiovascular outcomes. 28 It has been reported that there is a lack of evidence about rural cardiovascular disease prevention and ‘characteristics associated with quality of care’, which highlights the need for more programmes in rural primary care, especially for high-risk patients.…”