The Report of Community-Based and Government-Endorsed Screening Program of Atrial Fibrillation in Taiwan

Abstract

Background: The community-based AF screening program incorporated into the government-endorsed health care system is rarely reported in Asian countries. Objectives: We aimed to test the feasibility of adding AF screening into the preexistent adult health check program, report the AF detection rate and percentages of OAC prescriptions before and after AF screening with the involvement of public health care system. Methods: We performed this program in 3 counties in Taiwan which have their own official preexistent adult health check programs conducted by public health bureaus for years. We cooperated with the public health bureaus of 3 counties and performed single-lead 30-second ECG recording for every participants. Results: AF screening was performed in 199 sessions with 23,572 participants. AF was detected in 278 subjects with a detection rate of 1.19% (age >65 years: 2.39%; >75 years: 3.73%). The mean CHA2DS2-VASc score of these 278 subjects was 2.36, with 91% of them had a score >1 (males) or >2 (females). The number needed to screen was 42 and 27 for subjects aged >65 and >75 years, respectively. The prescription rate of OACs significantly increased from 11.4% to 60.6% in Chiayi county and from 15.8% to 50.0% in Keelung city after screening (both p values <0.001). Conclusions: The first community-based and government-endorsed AF screening project in Taiwan demonstrated that actions to detect AF, well education, and well-organized transferring plan after AF being detected with the involvements of public health care system could result in the substantial increase in the prescription rate of OACs.

Atrial fibrillation: epidemiology, screening and digital health

“…Considering all the above AF related complications, efforts have been made to reduce the healthcare burden by use of screening focused on high risk populations, 33 or targeted at community based screening programmes. 34 Importantly, while early AF diagnosis is intended to detect AF among individuals with AF-related symptoms, screening invites individuals without AF-related symptoms to undergo testing. 35 A recent meta-analysis of 4 RCTs (REHEARSE-AF, SCREEN-AF, LOOP and STROKESTOP) with a total of 35,836 participants indicated that AF screening was associated with a reduction in stroke as compared with no screening, (RR 0.91, 95% CI 0.84–0.99).…”