Validity of daily self-pulse palpation over two weeks for screening for atrial fibrillation among patients 65 years of age and older seeking primary care v1 (protocols.io.m2ec8be)

protocols.io ◽  
2018 ◽  
Author(s):  
Faris Ghazal
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Pulse Palpation

scholarly journals Electrocardiographic screening in primary care for cardiovascular disease risk and atrial fibrillation

2019 ◽  
Vol 20 ◽  
Author(s):  
Ralf E. Harskamp
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Diagnostic Testing ◽  
Routine Care ◽  
Pulse Palpation ◽  
Primary Care Patients ◽  
Ecg Abnormalities

Abstract Electrocardiograms (ECGs) are frequently recorded in primary care for screening purposes. An ECG is essential in diagnosing atrial fibrillation, and ECG abnormalities are associated with cardiovascular events. While recent studies show that ECGs adequately reclassify a proportion of patients based on the clinical risk score calculations, there are no data to support that this also results in improved health outcomes. When applied for screening for atrial fibrillation, more cases are found with routine care, but this would be undone when physicians would perform systematic pulse palpation. In most studies, the harms of routine ECG use (such as unnecessary diagnostic testing, emotional distress, increased health expenses) were poorly documented. As such, the routine performing of ECGs in asymptomatic primary care patients, whether it is for cardiovascular disease risk assessment or atrial fibrillation, cannot be recommended.

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 A Heart Rate Monitoring App (FibriCheck) for Atrial Fibrillation in General Practice: Pilot Usability Study (Preprint)

2020 ◽  
Author(s):  
Simon Gabriël Beerten ◽  
Tine Proesmans ◽  
Bert Vaes
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Patient Compliance ◽  
User Experience ◽  
Short Form ◽  
Heart Rhythm ◽  
Cluster Randomized Trial ◽  
Smartphone App ◽  
Pulse Palpation ◽  
A Charge

BACKGROUND Atrial fibrillation (AF) is a major risk factor for stroke. The current opportunistic screening procedure consists of pulse palpation and an electrocardiogram when an irregular rhythm is found. Smartphone apps that measure heart rhythm could be useful in increasing the detection of AF in a primary care setting. OBJECTIVE We conducted a pilot study with the smartphone app FibriCheck to assess whether the introduction of such an app is feasible. METHODS Four general practices across Flanders provided patient data for the study. Inclusion criteria for participants were aged 65 or older and a CHARGE-AF score of at least 10%. We excluded patients with known AF or a pacemaker. Participants were asked to measure at least twice a day with FibriCheck (for at least 14 days). They were provided the 36-Item Short Form Survey (SF-36) questionnaire both before and after the study, as well as different surveys concerning their user experience and general perception of technology. RESULTS There were 92 participants (36 women and 56 men). The study population was relatively homogenous concerning risk factors and medication use at baseline. During the study period, 5/86 (6%) participants were found to have AF (6 dropouts). The average study period was 23 days and the average number of measurements per day was 2.1. Patient compliance was variable, but high. On the whole, there were no appreciable changes in quality of life. The overall user experience and satisfaction were very high. CONCLUSIONS FibriCheck is a relatively easy-to-use smartphone app to complement AF screening in primary care. Its implementation in this setting is certainly achievable, and one can expect high rates of patient compliance. Based on these results, a planned cluster randomized trial will be going ahead. CLINICALTRIAL ClinicalTrials.gov NCT03509493; https://clinicaltrials.gov/ct2/show/NCT03509493

scholarly journals A Heart Rate Monitoring App (FibriCheck) for Atrial Fibrillation in General Practice: Pilot Usability Study

10.2196/24461 ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. e24461
Author(s):  
Simon Gabriël Beerten ◽  
Tine Proesmans ◽  
Bert Vaes
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Patient Compliance ◽  
User Experience ◽  
Short Form ◽  
Heart Rhythm ◽  
Cluster Randomized Trial ◽  
Smartphone App ◽  
Pulse Palpation ◽  
A Charge

Background Atrial fibrillation (AF) is a major risk factor for stroke. The current opportunistic screening procedure consists of pulse palpation and an electrocardiogram when an irregular rhythm is found. Smartphone apps that measure heart rhythm could be useful in increasing the detection of AF in a primary care setting. Objective We conducted a pilot study with the smartphone app FibriCheck to assess whether the introduction of such an app is feasible. Methods Four general practices across Flanders provided patient data for the study. Inclusion criteria for participants were aged 65 or older and a CHARGE-AF score of at least 10%. We excluded patients with known AF or a pacemaker. Participants were asked to measure at least twice a day with FibriCheck (for at least 14 days). They were provided the 36-Item Short Form Survey (SF-36) questionnaire both before and after the study, as well as different surveys concerning their user experience and general perception of technology. Results There were 92 participants (36 women and 56 men). The study population was relatively homogenous concerning risk factors and medication use at baseline. During the study period, 5/86 (6%) participants were found to have AF (6 dropouts). The average study period was 23 days and the average number of measurements per day was 2.1. Patient compliance was variable, but high. On the whole, there were no appreciable changes in quality of life. The overall user experience and satisfaction were very high. Conclusions FibriCheck is a relatively easy-to-use smartphone app to complement AF screening in primary care. Its implementation in this setting is certainly achievable, and one can expect high rates of patient compliance. Based on these results, a planned cluster randomized trial will be going ahead. Trial Registration ClinicalTrials.gov NCT03509493; https://clinicaltrials.gov/ct2/show/NCT03509493

scholarly journals Yield of two week holter monitoring and diagnostic accuracy of intermittent single-lead electrocardiogram recordings in screening for paroxysmal atrial fibrillation in primary care

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E.P.M Karregat ◽  
N Verbiest-Van Gurp ◽  
A Bouwman ◽  
S.B Uittenbogaart ◽  
J.C.L Himmelreich ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
False Positive ◽  
Expert Panel ◽  
Holter Monitoring ◽  
Detection Algorithm ◽  
Pulse Palpation ◽  
Increased Risk

Abstract Background Timely detection of atrial fibrillation (AF) is important because of its increased risk of thrombo-embolic events. Single time point screening interventions for AF are hindered because of AF's often paroxysmal nature. Community based prevalence of paroxysmal AF (pAF), however, is scarcely investigated. To detect pAF, often a Holter for prolonged electrocardiographic monitoring is used. Holter monitoring, however, is less appropriate for screening purposes because of its high burden for asymptomatic patients. Intermittent screening using a single-lead electrocardiogram (1L-ECG) device can offer a less burdensome alternative. Purpose To determine A) the diagnostic yield of two week Holter monitoring in screening for pAF after a negative 12-lead (12L-)ECG, B) the diagnostic accuracy of an intermittently used 1L-ECG device, and C) how often an expert panel is able to accurately diagnose AF by visually assessing the 1L-ECG recordings of patients with ≥1 algorithm-positive 1L-ECG recording(s). We used the Holter monitor as reference standard. Methods Patients of 65 years and older participated in an opportunistic screening study for AF. They received three screening tests (pulse palpation, electronic sphygmomanometer and a 1L-ECG device both with built-in AF detection algorithm). A 12L-ECG was recorded whenever at least one screening test was positive, supplemented with 10% of patients with three negative tests. We invited patients with a negative 12L-ECG to use a 1L-ECG device thrice daily and perform Holter monitoring for two weeks. We report the prevalence of pAF found by Holter monitoring and calculate the diagnostic accuracy of the 1L-ECG device's built-in AF detection algorithm. All 1L-ECG recordings of patients with ≥1 positive algorithm result were subsequently visually assessed by an expert panel of three cardiologists. Results We included 270 patients, of whom four had pAF on a median of 8.5 days of Holter monitoring: prevalence 1.5% (95%-CI: 0.4–3.8%). 205 patients were simultaneously screened with 1L-ECG recordings and Holter monitoring. Sensitivity was 67% (95%-CI: 9–99%), specificity 69% (95%-CI: 62–75%), positive predictive value 3% (95%-CI: 1–7%) and negative predictive value 99% (95%-CI: 97–100%) for diagnosing pAF based on the 1L-ECG device's built-in AF detection algorithm. Out of 65 patients with ≥1 algorithm-positive 1L-ECG recording(s), seven were classified as pAF after visual assessment by the expert panel. Six of these were false-positive. In 24 cases the expert panel could not interpret the 1L-ECGs. Conclusion We found a low prevalence of pAF using Holter monitoring in elderly primary care patients, with a negative 12L-ECG. The diagnostic accuracy of the built-in AF detection algorithm of an intermittently used 1L-ECG device is limited with a high false-positive rate. Cardiologists' assessment of algorithm-positive intermittent 1L-ECGs did not sufficiently improve accuracy to make a reliable diagnosis. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by ZonMw (The Netherlands Organisation for Health Research and Development)

scholarly journals Performance of pulse palpation compared to one‐lead ECG in atrial fibrillation screening

2021 ◽  
Author(s):  
Katrin Kemp Gudmundsdottir ◽  
Tove Fredriksson ◽  
Emma Svennberg ◽  
Faris Al‐Khalili ◽  
Leif Friberg ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulse Palpation

scholarly journals CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001459
Author(s):  
Jelle C L Himmelreich ◽  
Wim A M Lucassen ◽  
Ralf E Harskamp ◽  
Claire Aussems ◽  
Henk C P M van Weert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
High Risk ◽  
The Netherlands ◽  
Patient Selection ◽  
Low Cost ◽  
Calibration Plot ◽  
Primary Care Data ◽  
C Statistic ◽  
Kaplan Meier

AimsTo validate a multivariable risk prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF)) for 5-year risk of atrial fibrillation (AF) in routinely collected primary care data and to assess CHARGE-AF’s potential for automated, low-cost selection of patients at high risk for AF based on routine primary care data.MethodsWe included patients aged ≥40 years, free of AF and with complete CHARGE-AF variables at baseline, 1 January 2014, in a representative, nationwide routine primary care database in the Netherlands (Nivel-PCD). We validated CHARGE-AF for 5-year observed AF incidence using the C-statistic for discrimination, and calibration plot and stratified Kaplan-Meier plot for calibration. We compared CHARGE-AF with other predictors and assessed implications of using different CHARGE-AF cut-offs to select high-risk patients.ResultsAmong 111 475 patients free of AF and with complete CHARGE-AF variables at baseline (17.2% of all patients aged ≥40 years and free of AF), mean age was 65.5 years, and 53% were female. Complete CHARGE-AF cases were older and had higher AF incidence and cardiovascular comorbidity rate than incomplete cases. There were 5264 (4.7%) new AF cases during 5-year follow-up among complete cases. CHARGE-AF’s C-statistic for new AF was 0.74 (95% CI 0.73 to 0.74). The calibration plot showed slight risk underestimation in low-risk deciles and overestimation of absolute AF risk in those with highest predicted risk. The Kaplan-Meier plot with categories <2.5%, 2.5%–5% and >5% predicted 5-year risk was highly accurate. CHARGE-AF outperformed CHA2DS2-VASc (Cardiac failure or dysfunction, Hypertension, Age >=75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [Female]) and age alone as predictors for AF. Dichotomisation at cut-offs of 2.5%, 5% and 10% baseline CHARGE-AF risk all showed merits for patient selection in AF screening efforts.ConclusionIn patients with complete baseline CHARGE-AF data through routine Dutch primary care, CHARGE-AF accurately assessed AF risk among older primary care patients, outperformed both CHA2DS2-VASc and age alone as predictors for AF and showed potential for automated, low-cost patient selection in AF screening.

scholarly journals Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033061
Author(s):  
Mark Lown ◽  
Christopher R Wilcox ◽  
Stephanie Hughes ◽  
Miriam Santer ◽  
George Lewith ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Qualitative Study ◽  
Decision Aids ◽  
Care Practice ◽  
Semistructured Interview ◽  
Interview Guide ◽  
Registration Number ◽  
The Cost ◽  
Inductive Thematic Analysis

ObjectivesThere has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients’ views and understanding of AF and AF screening to determine acceptability and inform future recommendations.SettingA single primary care practice in Hampshire, UK.Participants15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsParticipants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening.ConclusionsOur study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening.Trial registration numberISRCTN 17495003.

Initiation of anticoagulation in atrial fibrillation by primary care physicians: Results of a telephone survey

2021 ◽  
Author(s):  
Stephanie Carlin ◽  
Alison Bond ◽  
Peter Gross ◽  
Alan Bell ◽  
James Douketis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Telephone Survey
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