Atrial fibrillation screening using smart electrocardiogram recorder and investigation of anticoagulation status in patients with non-valvular atrial fibrillation

Abstract

Objective To assess the feasibility of screening for atrial fibrillation (AF) using a smart portable single-lead electrocardiogram(ECG) device and to investigate the epidemiological characteristics, anticoagulant status of non-valvular atrial fibrillation (NVAF). Methods NVAF patients detected with a smart single-lead ECG device (AliveCor) at outpatient AF screening points and cooperative communities were included in this study. A questionnaire survey was conducted to obtain the epidemiological characteristics, status of taking anticoagulants, and the proportion of taking non-Vitman K antagonist oral anticoagulants (NOACs) among these patients. Results From June 2017 to May 2018, 6 593 persons underwent the AF screening in our screening point and cooperating community hospitals. Six hundred and forty-eight (9.8%) patients were diagnosed with AF. The overall prevalence of AF in the community was 3.5% (26/747), and in outpatient clinics was 10.6% (622/5 846). Five hundred and four (7.6%) were NVAF, among whom 472(93.7%) responded to our questionnaire, including 302 men (64.0%) and 170 women (36.0%). The average age was(66.9±10.3)years. The average CHA2DS2-VASc score was 2.3±1.4. Fifty-seven patients (12.1%) had a history of stroke/transient ischemic attack(TIA), 22 patients (4.7%) had a history of bleeding events. Hypertension was the most common complication (56.8%) of these NVAF patients. The total patients with NVAF received anti-thrombotic therapy was 63.3%. Stratified by CHA2DS2-VASc scores, the rate of taking antithrombotic drugs in low-risk (CHA2DS2-VASc score=0) group was 50.0%, that in the medium-risk (CHA2DS2-VASc score=1) group was 57.0%, and in high-risk (CHA2DS2-VASc score≥2) group was 67.3%, respectively. The rate of anti-thrombotic therapy increased with the risk of stroke increases (P<0.05). Logistic regression analysis showed that the coronary heart disease [OR=2.053, 95%CI 1.349-3.124, P=0.001], previous stroked history[OR=2.136, 95%CI 1.106-4.126, P=0.024] and hyperlipidemia [OR=1.574, 95%CI 1.009-2.454, P=0.045] were the independent risk factors affecting the use of anti-thrombotic therapy. Overall 36.2% of the patients were on anticoagulant drugs. The anticoagulant rates were 29.5%, 37.4% and 36.8% in the low, middle and high-risk group, respectively. The anticoagulant rate was not significantly different among these groups. Previous bleeding history was independently related with anti-coagulation (OR=3.266, P=0.009). NOACs accounted for 17.5% of the patients on anti-coagulation. Conclusion The smart single lead ECG device is effective in fast AF screening. The rate of anti-thrombotic therapy increased with the stroke risk increased, while the rate of anti-coagulation did not. Previous bleeding history was independently related with anti-coagulation. Warfarin is currently the mainstream anticoagulant agent, and the application rate of NOACs is still at a low level. Key words: Atrial fibrillation; Screening; Anticoagulation