Photo Credit: Pornpak Khunatorn

The following is a summary of “Screening for undiagnosed atrial fibrillation using a single-lead electrocardiogram at primary care visits: patient uptake and practitioner perspectives from the VITAL-AF trial,” published in the June 2023 issue of Primary Care by Atlas, et al.

Atrial fibrillation (AF) is a common condition that increases the risk of stroke if left undiagnosed. Screening for AF using a simple and quick test could help identify individuals who would benefit from preventive measures such as anticoagulants. For a study, researchers sought to assess the acceptability of AF screening using a 30-second single-lead electrocardiogram (SL-ECG) among patients and primary care practitioners (PCPs) during outpatient visits.

The study conducted secondary analyses of a cluster randomized trial involving patients aged 65 and older without known AF and their PCPs. Screening using an SL-ECG was performed by medical assistants during check-in at intervention sites, with patients providing verbal consent. PCPs were notified of “possible AF” results, and their management approach was at their discretion. Control practices continued with usual care. After the trial, PCPs were surveyed about their views on AF screening. The outcomes assessed included screening uptake and results and PCP preferences for screening methods.

A total of 15,393 patients were seen in the intervention practices, with a mean age of 73.9 years and 59.7% female. Screening occurred in 78% of the 38,502 encounters, and 91% of the patients completed at least one screening. The positive predictive value of a “Possible AF” result on the SL-ECG was 9.5% before a new AF diagnosis, accounting for 4.7% of the SL-ECG tracings. Same-day 12-lead electrocardiograms (ECGs) were slightly more frequent in the intervention group (7.0%) compared to the control group (6.2%). A survey of 208 PCPs (73.6% response rate; 78.9% from the intervention group, 67.7% from the control group) revealed that most PCPs favored screening for AF (87.2% vs. 83.6%, respectively), with intervention PCPs showing a preference for SL-ECG screening (86%) and control PCPs favoring pulse palpation (65%). Both groups expressed uncertainty regarding AF screening outside of office visits using patch monitors (47% unsure) or consumer devices (54% unsure).

Although the benefits and risks of AF screening are not yet fully established, the study found that most older patients were willing to undergo screening, and PCPs could effectively manage the results of SL-ECG screening. PCPs exposed to the SL-ECG device preferred it over pulse palpation. There needed more certainty among PCPs regarding AF screening outside of office visits. The findings supported the feasibility of routine primary care screening for AF.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02087-5