Feasibility And Acceptability Of Atrial Fibrillation Screening Using A Hand-Held ECG Device In General Practice Setting In Hong Kong

Abstract

General practitioners (GPs) can play an important role in atrial fibrillation (AF) screening but 12-lead ECG is not ready available in most GP clinics in Hong Kong. We evaluated the acceptability of AF screening using a handheld ECG device with automated AF diagnostics in GP setting in Hong Kong. Patients aged ≥65 years underwent AF screening in 9 GP clinics using a handheld single-lead ECG device (AliveCor) between March 2015 and June 2016. All ECGs were over-read by a cardiologist. Primary outcome was the prevalence of newly diagnosed AF. Patient and GP’s awareness and acceptability of AF screening was assessed. A total of 1041 patients age ≥65 years were screened. Overall AF prevalence was 2.6% (n=26) and newly identified AF 1.5% (n=15). Mean age of newly diagnosed AF patients was 77±6.7 years with mean CHA2DS2-VASc score of 3.9±1.6. Among patients with known AF, 45.5% were prescribed oral anticoagulants (OAC) (18.2% warfarin, 27.3% NOAC) and 54.5% antiplatelet therapy. Patient awareness of AF was low with 36.4% unfamiliar with AF and 63.6% unaware of the risk of AF related stroke (even in patients on OAC). All patients agreed handheld ECG was easy to operate and willing to undergo repeated screening in future GP visits. 86% of GPs considered handheld ECG was useful for AF screening and would use it in their daily practice. At baseline, 47% of GPs used CHA2D2-VASc score to assess AF related stroke risk which increased to 71% at the end of the study. AF screening using handheld ECG was feasible in a GP setting and acceptable to both GPs and patients. A significant number of newly diagnosed AF and known AF but undertreated patients were identified who would be suitable for OAC therapy for stroke prevention. Improvement in AF awareness may promote the benefits of AF screening.