The feasibility of population screening for paroxysmal atrial fibrillation using hand-held electrocardiogram devices

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.

Reliability of single-lead electrocardiogram interpretation to detect atrial fibrillation: insights from the SAFER feasibility study

“…Participants were invited to attend a screening visit at their general practice, where a practice nurse showed the participant how to use the device, and supervised the participant recording the first ECG including reviewing ECG quality. 15 Participants were then asked to record 4 ECGs per day for either 1, 2, or 4 weeks. The ECGs were transferred to a central database for analysis and review.…”