The Heart Rhythm Society/American College of Physicians Atrial Fibrillation Screening and Education Initiative

Rosenfeld, Lynda E.; Amin, Alpesh; Hsu, Jonathan C.; Oxner, Asa; Hills, Mellanie True; Frankel, David S.

doi:10.1016/j.hrthm.2019.04.007

Cited by 13 publications

(14 citation statements)

References 21 publications

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Section: Discussionmentioning

confidence: 99%

“…Participants were quite satisfied with the screening, and 90.6% agreed with the statement that they learnt more about AF. 29 Another single-point study shows feasibility in a national screening programme in Belgium. 30 Miscellaneous monitoring systems Activity monitors, for example, smartwatches, often record heart rate by photoplethysmography and are promising for AF detection when supplemented with sophisticated learning algorithms, but they still do Open access not produce diagnostic ECGs and if abnormalities are detected, further confirmation with an ECG is required.…”

Section: Handheld Ecg After Strokementioning

confidence: 99%

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Patient-reported feasibility of chest and thumb ECG after cryptogenic stroke in Sweden: an observational study

2020

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ObjectivesThe aim of this study was to assess the feasibility, based on a questionnaire, of the chest and thumb ECG system Coala Heart Monitor in patients who recently had a stroke.DesignObservational study.SettingTwo stroke units, Region Gävleborg, Sweden.Participants and interventionsThis study, Transient ECG Assessment in Stroke Evaluation (TEASE), included patients who had a stroke between 2017 and 2019. Patients eligible for anticoagulation in the presence of atrial fibrillation were scheduled for 28 days monitoring.Primary and secondary outcome measuresThe questionnaire regarding feasibility of monitoring included seven questions, using a 100 mm Visual Analogue Scale which covered overall satisfaction, technical feasibility, remember to monitor, physical application, feeling of security, help from others and recommendation to others. A lower score indicated better outcome.ResultsThe prespecified number of 100 patients underwent the monitoring and 83 out of the 97 alive patients returned the questionnaire (response rate 85.6%). The median age was 69.5 years, mean CHA2DS2-VASc score was 4.4±1.3 points and 59.0% were men (n=49). The median time from index stroke to start of monitoring was 7.0 days. Patients performed on average 90.1%±15.0% of scheduled ECG-transmissions. In all seven questions, the median score ranged from 4 to 8. The vast majority reported acceptable outcomes, that is, the 95th percentile ranged from 30 to 54. There was no significant difference between men and women with regard to any of the seven questions (p values ranging from 0.117 to 0.849). Two of the seven outcome scores correlated significantly to patient age (Spearman’s r=−0.238 and r=−0.308, and p values 0.031 and 0.005 for ‘overall satisfaction’ and ‘remember to monitor’, respectively).ConclusionIn stroke survivors, chest and thumb ECG two times per day over a period of 4 weeks is feasible from a patient’s perspective. The Coala Heart Monitor provides a valuable and convenient tool for monitoring after stroke.Trial registration numberNCT03301662.

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Section: Discussionmentioning

confidence: 99%

Section: Handheld Ecg After Strokementioning

confidence: 99%

Patient-reported feasibility of chest and thumb ECG after cryptogenic stroke in Sweden: an observational study

2020

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“…However, annual ECG checks or single-time handheld ECG screens may still underestimate the prevalence of AF because cases of paroxysmal AF may not be captured. Innovative approaches involving current mobile and wireless technologies to record multiple ECG snapshots with patient-activated handheld single-lead ECG devices may help improve the detection rate [ 25 ]. This was demonstrated in the STROKESTOP study, where 0.5% new AF was identified with the first screen, and after 2 weeks of intermittent twice-daily screening, the yield of new AF increased to 3% [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Detection rate and treatment gap for atrial fibrillation identified through screening in community health centers in China (AF-CATCH): A prospective multicenter study

et al. 2020

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Background Atrial fibrillation (AF) is underdiagnosed and especially undertreated in China. We aimed to investigate the prevalence of unknown and untreated AF in community residents (≥65 years old) and to determine whether an education intervention could improve oral anticoagulant (OAC) prescription. Methods and findings We performed a single–time point screening for AF with a handheld single-lead electrocardiography (ECG) in Chinese residents (≥65 years old) in 5 community health centers in Shanghai from April to September 2017. Disease education and advice on referral to specialist clinics for OAC treatment were provided to all patients with actionable AF (newly detected or undertreated known AF) at the time of screening, and education was reinforced at 1 month. Follow-up occurred at 12 months. In total, 4,531 participants were screened (response rate 94.7%, mean age 71.6 ± 6.3 years, 44% male). Overall AF prevalence was 4.0% (known AF 3.5% [ n = 161], new AF 0.5% [ n = 22]). The 183 patients with AF were older ( p < 0.001), taller ( p = 0.02), and more likely to be male ( p = 0.01), and they had a higher prevalence of cardiovascular disease than those without AF ( p < 0.001). In total, 85% (155/183) of patients were recommended for OAC treatment by the established guidelines (CHA 2 DS 2 -VASc ≥ 2 for men; ≥ 3 for women). OAC prescription rate for known AF was 20% (28/138), and actionable AF constituted 2.8% of all those screened. At the 12-month follow-up in 103 patients (81% complete), despite disease education and advice on specialist referral, only 17 attended specialist clinics, and 4 were prescribed OAC. Of those not attending specialist clinics, 71 chose instead to attend community health centers or secondary hospital clinics, with none prescribed OAC, and 15 had no review. Of the 17 patients with new AF and a class 1 recommendation for OAC, only 3 attended a specialist clinic, and none were prescribed OAC. Of the 28 AF patients taking OAC at baseline, OAC was no longer taken in 4. Ischemic stroke ( n = 2) or death ( n = 3) occurred in 5/126 (4%), with none receiving OAC. As screening was performed at a single time point, some paroxysmal AF cases may have been missed; thus, the rate of new AF may be underestimated. Conclusions We demonstrated a noticeable gap in AF detection and treatment in community-based elderly Chinese: actionable AF constituted a high proportion of those screened. Disease education and advice on specialist referral are insufficient to close the gap. Before more frequent or intensive screening for unknown AF could be recommended in China, greater efforts must be made to increase appropriate OAC therapy in known AF to prevent AF-related stroke....

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“…Although some studies have evaluated the impact of educational programmes on improving AF knowledge of the general public [10] and individuals at high risk of AF [11], none of these studies utilised a psychometrically validated tool. These limitations highlight the need for a psychometrically validated tool that would be suitable for assessing knowledge of AF in a range of populations.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of an Atrial Fibrillation Knowledge Assessment Tool (AFKAT)

Abubakar

Wimmer

Bereznicki

et al. 2020

IJERPH

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Assessing and improving public knowledge of atrial fibrillation (AF) could increase its detection rate and the subsequent use of stroke prevention therapies. However, there is no validated AF knowledge assessment tool applicable to the general population, including those at risk of AF. Therefore, we aimed to develop and validate such a tool. The tool was developed from a literature review and discussion with subject matter experts. Content validity was ensured by a ten-member panel of experts comprising cardiologists and pharmacists. An online validation survey was conducted and reported based on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). The survey evaluated the tool performance by construct validity, internal consistency reliability, item discrimination, difficulty index and ease of readability. The survey participants included 14 general medical specialists, 20 fourth-year and 33 second-year undergraduate pharmacy students, and 122 members of the general public. The tool had satisfactory content validity, with a scale content validity index of 0.8. The mean percentage knowledge scores for general medical specialists and fourth-year pharmacy students were higher than second-year pharmacy students, followed by the general public (92.9%, 87.6%, 68.5% and 53.4%, respectively; p-value < 0.001), supporting construct validity. The tool had good internal consistency reliability (Cronbach’s alpha = 0.91). The item-total correlation was in the preferred range of 0.23 to 0.71. The Atrial Fibrillation Knowledge Assessment Tool is a valid instrument and can be used to investigate AF knowledge of the general population.

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The Heart Rhythm Society/American College of Physicians Atrial Fibrillation Screening and Education Initiative

Cited by 13 publications

References 21 publications

Patient-reported feasibility of chest and thumb ECG after cryptogenic stroke in Sweden: an observational study

Patient-reported feasibility of chest and thumb ECG after cryptogenic stroke in Sweden: an observational study

Detection rate and treatment gap for atrial fibrillation identified through screening in community health centers in China (AF-CATCH): A prospective multicenter study

Development and Validation of an Atrial Fibrillation Knowledge Assessment Tool (AFKAT)

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