General population screening for atrial fibrillation with an automated rhythm-detection blood pressure device

2021 ◽  
Vol 322 ◽  
pp. 265-270
Author(s):  
Gentian Denas ◽  
Alessandro Battaggia ◽  
Massimo Fusello ◽  
Bruno Franco-Novelletto ◽  
Maurizio Cancian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
General Population ◽  
Population Screening ◽  
Blood Pressure Device

scholarly journals Population-Based Screening or Targeted Screening Based on Initial Clinical Risk Assessment for Atrial Fibrillation: A Report from the Huawei Heart Study

2020 ◽  
Vol 9 (5) ◽  
pp. 1493
Author(s):  
Yutao Guo ◽  
Hao Wang ◽  
Hui Zhang ◽  
Yundai Chen ◽  
Gregory Y. H. Lip
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Population Based ◽  
Population Screening ◽  
Smart Devices ◽  
Preventive Strategy ◽  
Population Approach ◽  
Clinical Risk ◽  
Heart Study ◽  
Targeted Screening

Background: A general-population approach has been advocated to improve the screening of patients with atrial fibrillation (AF). A more pragmatic alternative may be targeted screening of patients at high risk of developing AF. We assess the value of a simple clinical risk score, C2HEST (C2, coronary artery disease/chronic obstructive pulmonary disease; COPD (1 point each); H, hypertension; E, elderly (age ≥75, doubled); S, systolic heart failure; HF (doubled); T, hyperthyroidism)); to facilitate population screening and detection of incident AF in the general population, in a prespecified ancillary analysis of the Huawei Heart Study. Methods: The Huawei Heart Study investigated general population screening for AF, identified using photoplethysmography (PPG)-based HUAWEI smart devices. We compared the value of a general population approach to a target screening approach between 26 October 2018 and 20 November 2019. Results: There were 644,124 individuals (mean age ± standard deviation, SD 34 ± 11; female 15.9%) who monitored their pulse rhythm using smart devices, among which 209,274 individuals (mean age 34 years, SD11; 10.6% female) completed the questionnaire on cardiovascular risk factors, with 739 detecting AF. Of these, 31.4% (n = 65,810) subjects reported palpitations. The median (interquartile range, IQR) duration to first detected AF was 11 (1–46), 6 (1–49), and 4 (1–24) in the population with low, intermediate, and high C2HEST score category, respectively (p = 0.03). Detected AF events rates increased with increasing C2HEST score points, stratified by age (p for trend, p < 0.001). Hazard ratios of the components of the C2HEST score for detected AF were between 1.31 and 2.75. A combination of symptomatic palpitations and C2HEST score increased prediction of AF detection, compared to using C2HEST score alone (c-indexes 0.72 vs. 0.76, Delong test, p < 0.001). Conclusions: The C2HEST score, especially when combined with symptoms, could facilitate a targeted population-based screening and preventive strategy for AF.

scholarly journals Atrial fibrillation detection in primary care during blood pressure measurements and using a smartphone cardiac monitor

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
John D. Sluyter ◽  
Robert Scragg ◽  
Malakai ‘Ofanoa ◽  
Ralph A. H. Stewart
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Primary Care ◽  
Discrimination Performance ◽  
Screening Methods ◽  
Net Benefit ◽  
Pulse Rate Variability ◽  
Cardiac Monitor ◽  
Primary Care Patients ◽  
Blood Pressure Device

AbstractImproved atrial fibrillation (AF) screening methods are required. We detected AF with pulse rate variability (PRV) parameters using a blood pressure device (BP+; Uscom, Sydney, Australia) and with a Kardia Mobile Cardiac Monitor (KMCM; AliveCor, Mountain View, CA). In 421 primary care patients (mean (range) age: 72 (31–99) years), we diagnosed AF (n = 133) from 12-lead electrocardiogram recordings, and performed PRV and KMCM measurements. PRV parameters detected AF with area under curve (AUC) values of up to 0.92. Using the mean of two sequential readings increased AUC to up to 0.94 and improved positive predictive value at a given sensitivity (by up to 18%). The KMCM detected AF with 83% sensitivity and 68% specificity. 89 KMCM recordings were “unclassified” or blank, and PRV detected AF in these with AUC values of up to 0.88. When non-AF arrhythmias (n = 56) were excluded, the KMCM device had increased specificity (73%) and PRV had higher discrimination performance (maximum AUC = 0.96). In decision curve analysis, all PRV parameters consistently achieved a positive net benefit across the range of clinical thresholds. In primary care, AF can be detected by PRV accurately and by KMCM, especially in the absence of non-AF arrhythmias or when combinations of measurements are used.

scholarly journals Distribution and risk profile of atrial fibrillation patterns among women and men from the general population

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M J Tilly ◽  
Z Lu ◽  
S Geurts ◽  
M A Ikram ◽  
M P M De Maat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
General Population ◽  
Population Based ◽  
Mixed Effect ◽  
Duration Of Symptoms ◽  
Men And Women

Abstract Background In a clinical setting, atrial fibrillation (AF) subgroups are defined, including paroxysmal, persistent, and permanent AF. These subgroups differ in terms of clinical characteristics, management strategy, and long-term outcomes. Application of clinical classifications in population-based settings is challenging as they are based on the duration of symptoms, recurrence, and treatment. Purpose We aim to develop an objective and standardized classification for AF patterns in the general population and examine the associated cardiovascular risk profiles and outcomes for the identified AF patterns. Methods Participants with only one reported AF episode were categorized as single-documented AF, if at least two separate AF episodes were reported as multiple-documented AF and as longstanding persistent AF if at least two consecutive ECG's at the research center showed AF, not followed by an ECG showing sinus rhythm. We fitted mixed effect models with age as time scale to characterize sex-specific cardiovascular risk factor trajectories preceding each AF pattern. We further used Cox proportional hazard modelling to describe the risk of coronary heart disease (CHD), heart failure (HF), stroke, and all-cause mortality following AF. Results We included 14,620 men and women aged ≥45 years. 1137 participants were categorized as single-documented AF, 208 as multiple-documented AF, and 57 as longstanding persistent AF. We identified significant differences in the preceding trajectories of weight, body mass index, systolic blood pressure, diastolic blood pressure, waist circumference, hip circumference, and waist-hip ratio with various AF patterns. In general, both men and women with persistent-elevated levels of these risk factors were prone to longstanding persistent AF. AF was associated with a large risk for subsequent CHD, HF, stroke, and mortality in the general population. Among the different AF patterns, single-documented AF conferred the largest risk of CHD [hazard ratio, 95% confidence interval: 1.92 (1.19–3.03)] and mortality [1.70 (1.41–2.07)] as compared to multiple-documented AF, and as compared to longstanding persistent AF [1.45 (0.72–2.90) and 3.66 (2.25–5.95), respectively]. Conclusion We developed a classification for AF patterns within a general population. We identified differences in risk factor trajectories preceding each AF pattern, which implies differences in pathophysiological mechanisms underlying AF. Participants with single-documented AF showed worse prognosis than those with multiple AF episodes. This might be due to the subgroup definition, since participants should live for a longer period of time to be categorized in the multiple-documented AF and longstanding persistent AF groups. This can also imply that participants suffering from multiple AF episodes are more frequently monitored, and treated for other risk factors. However, this could also suggest that singular AF episodes are not as innocent as commonly thought. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): - Erasmus MC Mrace grant. - Netherlands Organization for the Health Research and Development (ZonMw) Figure 1 Figure 2. Progosis of various AF patterns

Abstract W P153: Parental History of Stroke and Incident Atrial Fibrillation According to Blood Pressure Category in a General Urban Population: The Suita Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yoshihiro Kokubo ◽  
Makoto Watanabe ◽  
Takashi Kobayashi ◽  
Shiro Kamakura ◽  
Takeshi Aiba ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
General Population ◽  
Health Examination ◽  
Antihypertensive Medications ◽  
Parental History ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Drinking Status ◽  
History Of

Background and purpose: No prospective study has examined the relation between a parental history of stroke and the incidence of atrial fibrillation (AF) in a general population. We assessed the hypothesis that a parental history of stroke is associated with an increased risk of incident AF according to blood pressure (BP) category in a general population. Methods: A total of 6,918 participants (30 to 84 years old) initially free of AF were prospectively followed up for incident AF in the Suita Study. Standard 12-lead electrocardiograms were obtained from all subjects in the supine position. Each record was coded independently by 2 well-trained physicians using the Minnesota Code. Participants were diagnosed with AF if AF or atrial flutter was present on electrocardiograms obtained during a biannual routine health examination or if AF was indicated as a present illness by either annual questionnaires responses or participants' medical records. Well-trained nurses obtained information on parental history of stroke and on the participants' lifestyle. BPs were taken as the average of the second and third measurements. The category of systolic BP (SBP) was defined by the following criteria: normal SBP (<120 mm Hg), systolic prehypertension (120-139 mm Hg), and systolic hypertension (≥140 mm Hg and/or antihypertensive medications). Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were analyzed after adjusting for age, sex, body mass index, BP categories, diabetes, hyperlipidemia, smoking, and drinking status at baseline. Results: In 87,341 person-years of follow-up, 245 incident AF events occurred. A parental history of stroke was significance to the incidence of AF in men (adjusted HR, 1.47; 95% CIs, 1.03-2.10). Compared with normal SBP subjects without a parental history of stroke, the adjusted HRs (95% CIs) of incident AF in systolic hypertensive subjects were 2.18 (1.36-3.51) and 1.50 (1.01-2.23) for those with and without a parental history of stroke (P for interaction between parental history of stroke and SBP = 0.06). Conclusions: A parental history of stroke is a predictor of incident AF among systolic hypertensive subjects. For persons with a parental history of stroke, BP control would be important for AF prevention.

scholarly journals The Use of a Modified Blood Pressure Device to Detect Atrial Fibrillation in Outpatients

2020 ◽  
Vol 4 (2) ◽  
pp. 47
Author(s):  
Haroldas Razvadauskas ◽  
Laima Jankauskienė ◽  
Albinas Naudžiūnas
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Blood Pressure Device

Recurrent Stroke Risk in Pilots with Atrial Fibrillation

2020 ◽  
Vol 91 (4) ◽  
pp. 352-357
Author(s):  
Jessica Tedford ◽  
Valerie Skaggs ◽  
Ann Norris ◽  
Farhad Sahiar ◽  
Charles Mathers
Keyword(s):  
Atrial Fibrillation ◽  
General Population ◽  
Recurrent Events ◽  
Stroke Risk ◽  
Event Rate ◽  
Recurrent Stroke ◽  
Previous History ◽  
Recurrent Event ◽  
Recurrence Rates ◽  
Medical Certification

INTRODUCTION: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in the general population and is considered disqualifying aeromedically. This study is a unique examination of significant outcomes in aviators with previous history of both AF and stroke.METHODS: Pilots examined by the FAA between 2002 and 2012 who had had AF at some point during his or her medical history were reviewed, and those with an initial stroke or transient ischemic attack (TIA) during that time period were included in this study. All records were individually reviewed to determine stroke and AF history, medical certification history, and recurrent events. Variables collected included medical and behavior history, stroke type, gender, BMI, medication use, and any cardiovascular or neurological outcomes of interest. Major recurrent events included stroke, TIA, cerebrovascular accident, death, or other major events. These factors were used to calculate CHA2DS2-VASc scores.RESULTS: Of the 141 pilots selected for the study, 17.7% experienced a recurrent event. At 6 mo, the recurrent event rate was 5.0%; at 1 yr, 5.8%; at 3 yr 6.9%; and at 5 yr the recurrent event rate was 17.3%. No statistical difference between CHA2DS2-VASc scores was found as it pertained to number of recurrent events.DISCUSSION: We found no significant factors predicting risk of recurrent event and lower recurrence rates in pilots than the general population. This suggests CHA2DS2-VASc scores are not appropriate risk stratification tools in an aviation population and more research is necessary to determine risk of recurrent events in aviators with atrial fibrillation.Tedford J, Skaggs V, Norris A, Sahiar F, Mathers C. Recurrent stroke risk in pilots with atrial fibrillation. Aerosp Med Hum Perform. 2020; 91(4):352–357.

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