Reference
Gladstone DJ, et al. JAMA Cardiol 2021 Feb 24. Screening for Atrial Fibrillation in the Older Population: A Randomized Clinical Trial. doi: 10.1001/jamacardio.2021.0038. Online ahead of print.
Summary
In elderly patients, prolonged monitoring through new miniaturized and wearable devices was able to detect asymptomatic episodes of atrial fibrillation more frequently than standard routine check-ups alone. This made it possible to start anticoagulant therapy early, with the aim of preventing stroke episodes related to this arrhythmia.
Background
Atrial fibrillation is the most frequent cardiac arrhythmia, especially in the older population, with a prevalence of >10% in subjects ≥ 75 years old. This arrhythmia increases the risk of thrombo-embolic stroke, even when it occurs asymptomatically. Early identification of subclinical atrial fibrillation can, therefore, increase the use of oral anticoagulant therapy in order to more extensively prevent stroke episodes resulting from this arrhythmia.
Study characteristics
This multicenter randomized control trial, carried out in Canada and Germany, included a total of 856 individuals aged ≥ 75 with hypertension and no previous history of atrial fibrillation. The screening group wore a 2-week continuous electrocardiographic patch monitor, while the control group followed only the standard approach of routine clinical follow-up plus a pulse check and heart auscultation. The primary end-point was the identification of atrial fibrillation episodes within 6-months.
Results
Regarding the primary end-point, a total of 5.3% new atrial fibrillation episodes (median duration 6 hours) were detected in the screening group versus 0.5% in the control group (p = 0.001). In the continuous monitoring group, there was an approximately 11-fold increase in the relative risk of diagnosing atrial fibrillation episodes, corresponding to one additional detection of atrial fibrillation for every 21 subjects monitored. Based on these results and considering a 6 month period, anticoagulant therapy was initiated in 4.1% of patients in the screening group, versus 0.9% in the control group (p = 0.007).
What’s new?
This study showed that, in an unselected population of elderly individuals at increased risk of atrial fibrillation, continuous monitoring of the cardiac rhythm with a miniaturized and wearable device, even for a limited time, leads to a more accurate detection of asymptomatic atrial fibrillation episodes than standard clinical monitoring alone. Such detection was associated with an early initiation of oral anticoagulant therapy, with the aim of preventing stroke episodes related to such arrhythmia.
Written by Giuseppe Patti
