부산대학교 도서관

Introduction: It is estimated that approximately one third of ischemic strokes are caused by atrial fibrillation (AF), and in almost one third of these, there was no prior diagnosis of AF. Screening for AF could prevent these strokes, but is not included as a recommendation in the current AHA/ACC/HRS guideline. While a few studies have demonstrated that single timepoint screening for AF using pulse taking or ECG could be cost-effective for stroke prevention, the challenge is to find a scalable method using a handheld ECG as recommended by AF-SCREEN, which is feasible in the US managed care environment. The purpose of this study was to evaluate the utility of this approach to screening for AF in patients presenting to Kaiser Permanente ambulatory clinics for routine care using the AliveCor ™ handheld ECG device during intake.Methods: Patients aged 65 years or older were asked to use the AliveCor ™ device (adjacent to iPad ™) under the supervision of our trained clinical staff while obtaining the vital signs. A total of 10 devices were used in 5 different ambulatory clinics. Rhythm strips were generated and uploaded to a secure website. Unique patient data were entered for each strip and subsequently reviewed by 2 cardiologists. The electronic health record was then reviewed for each patient’s clinical information.Results: A total of 2286 patients 65 years and older were screened from 9-15-2014 to 1-31-2017. Mean age of the patients was 80 ± 11 years (range 65-96), 60% were males and 40% females. AF was detected in 117 (5.1%) patients, 81 of whom had a history of AF (3.5% of the total screened). There were 36 (1.6%) patients who had undiagnosed AF. The mean CHADsVASc score of the group with undiagnosed AF was 4.4 ±1.5 (range 1-9), and 98% had CHADsVASc ≥ 2. Of the 36 patients with undiagnosed AF, only 2 (6%) were on anticoagulant therapy.Conclusions: AF screening on a large scale using AliveCor ™ handheld ECG is practical, inexpensive and easily fits into the usual workflow of a busy ambulatory clinic in a manged care outpatient environment in the US. Up to 1.6% of patients 65 or older presenting to an ambulatory clinic may have undiagnosed AF, most of whom are at significant risk of stroke (CHADsVASc score of ≥2), and would benefit from screening and treatment for AF to prevent stroke.