Abstract
Background: A general-population approach has been advocated to improve the screening of patients with atrial fibrillation (AF). A more pragmatic alternative may be targeted screening of patients at high risk of developing AF. We assess the value of a simple clinical risk score, C2HEST (C2, coronary artery disease/chronic obstructive pulmonary disease; COPD (1 point each); H, hypertension; E, elderly (age ≥75, doubled); S, systolic heart failure; HF (doubled); T, hyperthyroidism)); to facilitate population screening and detection of incident AF in the general population, in a prespecified ancillary analysis of the Huawei Heart Study. Methods: The Huawei Heart Study investigated general population screening for AF, identified using photoplethysmography (PPG)-based HUAWEI smart devices. We compared the value of a general population approach to a target screening approach between 26 October 2018 and 20 November 2019. Results: There were 644,124 individuals (mean age ± standard deviation, SD 34 ± 11; female 15.9%) who monitored their pulse rhythm using smart devices, among which 209,274 individuals (mean age 34 years, SD11; 10.6% female) completed the questionnaire on cardiovascular risk factors, with 739 detecting AF. Of these, 31.4% (n = 65,810) subjects reported palpitations. The median (interquartile range, IQR) duration to first detected AF was 11 (1–46), 6 (1–49), and 4 (1–24) in the population with low, intermediate, and high C2HEST score category, respectively (p = 0.03). Detected AF events rates increased with increasing C2HEST score points, stratified by age (p for trend, p < 0.001). Hazard ratios of the components of the C2HEST score for detected AF were between 1.31 and 2.75. A combination of symptomatic palpitations and C2HEST score increased prediction of AF detection, compared to using C2HEST score alone (c-indexes 0.72 vs. 0.76, Delong test, p < 0.001). Conclusions: The C2HEST score, especially when combined with symptoms, could facilitate a targeted population-based screening and preventive strategy for AF.
Highlights
Atrial fibrillation (AF) is the commonest heart rhythm disorder, which increases the risk of stroke, death, dementia, and heart failure
Huawei smart technology was used for screening of AF in the general population, and the identified AF patients were transferred into a structured program of holistic and integrated care using a smartphone App [13]
The adult population aged over 18 years old could freely use AF screening with smart devices based on PPG technology (Huawei Technologies Co., Ltd., Shenzhen, China) across China, once the
Summary
Atrial fibrillation (AF) is the commonest heart rhythm disorder, which increases the risk of stroke, death, dementia, and heart failure. The HUAWEI Heart Study investigated the effectiveness of AF screening in a large population-based cohort using smart device based photoplethysmography (PPG) technology [5] It found that continuous home-monitoring with smart device-based PPG technology could be a feasible approach for AF screening, where the proportion of ‘suspected AF’ notifications was 0.2%, which increased with the highest proportion of ‘suspected AF’ detection of 2.8% in population aged ≥65 years [5]. This raises the question of whether AF screening should be a population-wide approach, with the associated logistic and cost issues, or should we use targeted screening of patients at high risk of developing AF?. Conclusions: The C2HEST score, especially when combined with symptoms, could facilitate a targeted population-based screening and preventive strategy for AF
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