scholarly journals Diagnostic Performance of a Smartphone‐Based Photoplethysmographic Application for Atrial Fibrillation Screening in a Primary Care Setting

2016 ◽  
Vol 5 (7) ◽  
Author(s):  
Pak‐Hei Chan ◽  
Chun‐Ka Wong ◽  
Yukkee C. Poh ◽  
Louise Pun ◽  
Wangie Wan‐Chiu Leung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Diagnostic Performance ◽  
Care Setting ◽  
Primary Care Setting

scholarly journals Secondary Prevention Post Stroke in Primary Care in an Asian Setting: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Vivek Bansal ◽  
Eng Sing Lee ◽  
Helen Smith
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Primary Care ◽  
Secondary Prevention ◽  
Retrospective Cohort ◽  
Care Setting ◽  
Primary Care Setting ◽  
Stroke Patients ◽  
Factors Associated ◽  
Post Stroke

Abstract Background: Stroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimal secondary prevention post-stroke helping patients make appropriate lifestyle changes and take medication in accordance with the recommended clinical practice guidelines.Methods: Our aim was to characterize the profile of patients who were being managed in primary care setting for secondary prevention of stroke. Our specific objectives were: (i) to examine the level of overall and individual risk factors control after an index-stroke event in patients visiting the primary care setting and (ii) to describe the factors associated with the achievement of overall risk factors control in post-stroke patients.Study Design: Retrospective cohort study.We conducted a study looking retrospectively at records from our electronic chronic disease database. Our study included post-stroke patients who visited public primary care setting in Singapore between 1st January 2012 to 31st December 2016. Based on AHA Stroke guidelines, we operationalized our outcome of secondary prevention post-stroke as overall control, which comprised of patients having blood pressure, lipids, and glucose reading (for those who had diabetes) all well-controlled. We conducted descriptive analysis and performed multivariable logistic analysis to determine factors associated with overall control.Results: There were 24,240 patients in our study. Overall control was better in post-stroke patients without diabetes (49.2%) as compared to those with diabetes (28.1%).Among post-stroke patients without diabetes, factors significantly associated with overall control were sex [OR: 1.23, 95% CI: 1.10, 1.39], ethnicity [OR: 0.72, 95% CI: 0.58, 0.90], BMI [OR: 0.72, 95% CI: 0.62, 0.84) and atrial fibrillation [OR: 1.47, 95% CI: 1.21, 1.78].Among post-stroke patients with diabetes, factors significantly associated with overall control were sex [OR: 1.28, 95% CI: 1.12, 1.46], ethnicity, BMI, atrial fibrillation[OR: 1.24; 95% CI: 1.02, 1.51], chronic kidney disease and smoking status.Conclusion: We reported a sub-optimal level of overall control. Among post-stroke patients, those with diabetes had a higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity were associated with poor overall control compared to Chinese.

scholarly journals Head-to-Head Comparison of the AliveCor Heart Monitor and Microlife WatchBP Office AFIB for Atrial Fibrillation Screening in a Primary Care Setting

Circulation ◽  
2017 ◽  
Vol 135 (1) ◽  
pp. 110-112 ◽  
Author(s):  
Pak-Hei Chan ◽  
Chun-Ka Wong ◽  
Louise Pun ◽  
Yu-Fai Wong ◽  
Michelle Man-Ying Wong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting

scholarly journals The effect of a case-finding app on the detection rate of atrial fibrillation compared with opportunistic screening in primary care patients: protocol for a cluster randomized trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Simon Gabriël Beerten ◽  
Tine Proesmans ◽  
Bert Vaes
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Randomized Trial ◽  
Paroxysmal Atrial Fibrillation ◽  
Detection Rate ◽  
Care Setting ◽  
Primary Care Setting ◽  
Cluster Randomized Trial ◽  
Opportunistic Screening ◽  
Cluster Randomized

Abstract Background Atrial fibrillation is a cardiac arrhythmia commonly encountered in a primary care setting. Current screening is limited to pulse palpation and ECG confirmation when an irregular pulse is found. Paroxysmal atrial fibrillation will, however, still be difficult to pick up. With the advent of smartphones, screening could be more cost-efficient by making use of simple applications, lowering the need for intensive screening to discover (paroxysmal) atrial fibrillation. Methods/design This cluster randomized trial will examine the effect of using a smartphone-based application such as FibriCheck® on the detection rate of atrial fibrillation in a Flemish general practice population. This study will be conducted in 22 primary care practices across the Flanders region of Belgium and will last 12 months. Patients above 65 years of age will be divided in control and intervention groups on the practice level. The control group will be subjected to standard opportunistic screening only, while the intervention group will be prescribed the FibriCheck® app on top of this opportunistic screening. The difference in detection rate between control and intervention groups will be calculated at the end of the study. We will use the online platform INTEGO for pseudonymized data collection and analysis, and risk calculation. Discussion Smartphone applications might offer a way to cost-effectively screen for (paroxysmal) atrial fibrillation in a primary care setting. This could open the door for the update of future screening guidelines. Trial registration ClinicalTrials.gov NCT04545723. Registered on September 10, 2020.

scholarly journals Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Heart ◽  
2020 ◽  
pp. heartjnl-2020-316904
Author(s):  
Louise Feldborg Lyckhage ◽  
Morten Lock Hansen ◽  
Jens Christian Toft ◽  
Susanne Lis Larsen ◽  
Bente Brendorp ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diagnostic Yield ◽  
Univariate Analysis ◽  
Holter Monitoring ◽  
Number Needed To Screen ◽  
Pulse Palpation ◽  
Diagnostic Benefit

Background and purposeThe diagnostic benefit of using continuous ECG (cECG) for poststroke atrial fibrillation (AF) screening in a primary care setting is unclear. We aimed to assess the diagnostic yield from screening patients who previously had a stroke with a 7-day Holter monitor.MethodsPatients older than 49 years, naive to AF, with an ischaemic stroke over 1 year before enrolment were included. In a primary care setting, all patients were screened for AF using pulse palpation, 12-lead ECG and 7-day Holter monitoring. Further, NT-proBNP was determined at baseline.Results7-day Holter monitoring uncovered AF in 17 of 366 patients (4.6% (95% CI 2.7 to 7.3)). The number needed to screen was 22 patients (14–37). 12-lead ECG uncovered AF in 3 patients (0.82% (95% CI 0.17 to 2.4)), and 122 patients had irregular pulse during pulse palpation (33.5% (95% CI 28.7 to 38.2)). When using 7-day Holter monitoring as reference standard, the sensitivity of pulse palpation and 12-lead ECG was 47% (95% CI 23% to 72%) and 18% (95% CI 4% to 43%). High levels (≥400 pg/mL) of NT-proBNP versus low levels (≤200 pg/mL) were not associated with AF in the univariate analysis nor when adjusted for age (OR 2.4 (95% CI 0.5 to 8.4) and 1.6 (95% CI 0.3 to 6.0)).ConclusionsA relevant proportion of patients with stroke more than 1 year before inclusion were diagnosed with AF through 7-day Holter monitoring. Given the low sensitivities of pulse palpation and 12-lead ECG, additional cECG may be considered during poststroke primary care follow-up.

scholarly journals Primary Care Atrial Fibrillation Service: outcomes from consultant-led anticoagulation assessment clinics in the primary care setting in the UK

BMJ Open ◽  
2015 ◽  
Vol 5 (12) ◽  
pp. e009267 ◽  
Author(s):  
Moloy Das ◽  
Lee Panter ◽  
Gareth J Wynn ◽  
Rob M Taylor ◽  
Neil Connor ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Service Outcomes ◽  
The Uk

scholarly journals Associations between common ECG abnormalities and out-of-hospital cardiac arrest

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000905 ◽  
Author(s):  
Marc Meller Søndergaard ◽  
Jonas Bille Nielsen ◽  
Rikke Nørmark Mortensen ◽  
Gunnar Gislason ◽  
Lars Køber ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Cardiac Arrest ◽  
Cardiac Disease ◽  
Care Setting ◽  
Primary Care Setting ◽  
Bundle Branch Block ◽  
St Depression ◽  
Ecg Abnormalities ◽  
Hospital Cardiac Arrest

BackgroundOut-of-hospital cardiac arrest (OHCA) is often the first manifestation of unrecognised cardiac disease. ECG abnormalities encountered in primary care settings may be warning signs of OHCA.ObjectiveWe examined the association between common ECG abnormalities and OHCA in a primary care setting.MethodsWe cross-linked individuals who had an ECG recording between 2001 and 2011 in a primary care setting with the Danish Cardiac Arrest Registry and identified OHCAs of presumed cardiac cause.ResultsA total of 326 227 individuals were included and 2667 (0,8%) suffered an OHCA. In Cox regression analyses, adjusted for age and sex, the following ECG findings were strongly associated with OHCA: ST-depression without concomitant atrial fibrillation (HR 2.79; 95% CI 2.45 to 3.18), left bundle branch block (LBBB; HR 3.44; 95% CI 2.85 to 4.14) and non-specific intraventricular block (NSIB; HR 3.15; 95% CI 2.58 to 3.83). Also associated with OHCA were atrial fibrillation (HR 1.89; 95% CI 1.63 to 2.18), Q-wave (HR 1.75; 95% CI 1.57 to 1.95), Cornell and Sokolow-Lyon criteria for left ventricular hypertrophy (HR 1.56; 95% CI 1.33 to 1.82 and HR 1.27; 95% CI 1.12 to 1.45, respectively), ST-elevation (HR 1.40; 95% CI 1.09 to 1.54) and right bundle branch block (HR 1.29; 95% CI 1.09 to 1.54). The association between ST-depression and OHCA diminished with concomitant atrial fibrillation (HR 1.79; 95% CI 1.42 to 2.24, p < 0.01 for interaction). Among patients suffering from OHCA, without a known cardiac disease at the time of the cardiac arrest, 14.2 % had LBBB, NSIB or ST-depression.ConclusionsSeveral common ECG findings obtained from a primary care setting are associated with OHCA.

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