Screening for Actionable Atrial Fibrillation in a Community Hospital

Roseboom, E. (Eva) (2017) Screening for Actionable Atrial Fibrillation in a Community Hospital. thesis, Medicine.

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Abstract

Aim To investigate the yield of screening for silent and undertreated atrial fibrillation (AF) in a community hospital using a single-lead hand-held ECG recording device with automatic detection (MyDiagnostick). Results of MyDiagnostick’s algorithm to detect AF are compared with pulse palpation and subsequent 12-lead ECG recording. Methods During preoperative consultation in patients >65 years, nurses carried out AF screening by pulse palpation and, in case of pulse irregularity, subsequent 12-lead ECG recording. Simultaneously, heart rhythm was checked by the MyDiagnostick, a hand-held single-lead ECG recorder with automated AF detection. Nurses were blinded from the results of the MyDiagnostick. The rhythm strips from the MyDiagnostick were reviewed by a cardiologist and compared to the verdict of manual pulse palpation (regular or irregular) and MyDiagnostick outcome (AF or no AF). Results In total, 505 consecutive patients (48.7% male, 51.3% female, median age 72 years) were screened. Forty-seven patients (9.3%) had a history of AF, all anticoagulated according to most recent guidelines. Screening detected two new patients with AF, both requiring anticoagulant therapy, and 19 patients with known AF. 28 patients had paroxysmal AF and did not display the arrhythmia during screening. The sensitivity of MyDiagnostick’s algorithm compared to manual pulse palpation was 100% versus 42.9%. Specificity was 95.2% and 94.1%, respectively. Independent predictors for the presence of AF were heart failure (OR 7.3, CI 1.35 – 39.77), male gender (OR 2.91, 95% CI 1.52 – 5.54), BMI >35 (OR 2.64, 95% CI 1.01 – 6.88) and increasing age (OR of 1.07 per year, 95% CI 1.01 – 1.13). Conclusion The prevalence of AF in history during in-hospital preoperative screening is high (9.3%), due to a combination of a population with more risk factors for the development of AF and more incidental findings due to frequent examination prior screening. Screening revealed new AF in only 0.4% of the patients. Manual pulse palpation for the detection of AF appears to be an inadequate screening method, compared with the MyDiagnostick.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Tieleman, Dr. R. G. and Location: and Martini Hospital Groningen, Department of Cardiology
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:42
Last Modified:	25 Jun 2020 10:42
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/345

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