Pooled yield of screening was greater in males across all age strata .
Neither the choice of screening methodology or device , the geographical region , nor the screening setting influenced the detection rate of AF .
The main limitation of this study is there are insufficient data on sociodemographic variables of the population s and possible ascertainment biases to explain the variance in the sample s. CONCLUSIONS People with screen-detected AF are at elevated calculated stroke risk : above age 65 , the majority have a Class-1 OAC recommendation for stroke prevention , and > 70 % have ≥1 additional stroke risk factor other than age/sex .
BACKGROUND The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation ( AF ) is not known .
Therefore , it is not possible to determine the number needed to screen ( NNS ) to identify one treatable new AF case ( NNS-Rx ) ( i.e. , Class-1 oral anticoagulation [ OAC ] treatment recommendation ) in each age stratum .
If the NNS-Rx is known for each age stratum , precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population /region to be screened .
Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded .
Therefore , we aim ed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata .
Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study
Background : Asymptomatic atrial fibrillation ( AF ) is increasingly common in the aging population and implicated in many ischemic strokes . Earlier identification of AF with appropriate anticoagulation may decrease stroke morbidity and mortality . Methods : We conducted a r and omized controlled trial of AF screening using an AliveCor Kardia monitor attached to a WiFi-enabled iPod to obtain ECGs ( iECGs ) in ambulatory patients . Patients ≥65 years of age with a CHADS-VASc score ≥2 free from AF were r and omized to the iECG arm or routine care ( RC ) . iECG participants acquired iECGs twice weekly over 12 months ( plus additional iECGs if symptomatic ) onto a secure study server with overread by an automated AF detection algorithm and by a cardiac physiologist and /or consultant cardiologist . Time to diagnosis of AF was the primary outcome measure . The overall cost of the devices , ECG interpretation , and patient management were captured and used to generate the cost per AF diagnosis in iECG patients . Clinical events and patient attitudes/experience were also evaluated . Results : We studied 1001 patients ( 500 iECG , 501 RC ) who were 72.6±5.4 years of age ; 534 were female . Mean CHADS-VASc score was 3.0 ( heart failure , 1.4 % ; hypertension , 54 % ; diabetes mellitus , 30 % ; prior stroke/transient ischemic attack , 6.5 % ; arterial disease , 15.9 % ; all CHADS-VASc risk factors were evenly distributed between groups ) . Nineteen patients in the iECG group were diagnosed with AF over the 12-month study period versus 5 in the RC arm ( hazard ratio , 3.9 ; 95 % confidence interval=1.4–10.4 ; P=0.007 ) at a cost per AF diagnosis of $ 10 780 ( £ 8255 ) . There was a similar number of stroke/transient ischemic attack/systemic embolic events ( 6 versus 10 , iECG versus RC ; hazard ratio=0.61 ; 95 % confidence interval=0.22–1.69 ; P=0.34 ) . The majority of iECG patients were satisfied with the device , finding it easy to use without restricting activities or causing anxiety . Conclusions : Screening with twice-weekly single-lead iECG with remote interpretation in ambulatory patients ≥65 years of age at increased risk of stroke is significantly more likely to identify incident AF than RC over a 12-month period . This approach is also highly acceptable to this group of patients , supporting further evaluation in an appropriately powered , event-driven clinical trial . Clinical Trial Registration : URL : https://www.is rct n.com . Unique identifier : IS RCT N10709813
Pooled yield of screening was greater in males across all age strata .
Neither the choice of screening methodology or device , the geographical region , nor the screening setting influenced the detection rate of AF .
The main limitation of this study is there are insufficient data on sociodemographic variables of the population s and possible ascertainment biases to explain the variance in the sample s. CONCLUSIONS People with screen-detected AF are at elevated calculated stroke risk : above age 65 , the majority have a Class-1 OAC recommendation for stroke prevention , and > 70 % have ≥1 additional stroke risk factor other than age/sex .
BACKGROUND The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation ( AF ) is not known .
Therefore , it is not possible to determine the number needed to screen ( NNS ) to identify one treatable new AF case ( NNS-Rx ) ( i.e. , Class-1 oral anticoagulation [ OAC ] treatment recommendation ) in each age stratum .
If the NNS-Rx is known for each age stratum , precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population /region to be screened .
Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded .
Therefore , we aim ed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata .