Abstract
Background:Screening for atrial fibrillation has the potential to significantly reduce cardiovascular morbidity and mortality. However, questions in regard to how to screen, on whom to screen, and the optimal setting of screening remain unanswered.Objective:To assess the applicability of a federal cardiac monitoring for atrial fibrillation (AF) screening and remote heart rhythm monitoring in patients at high cardiovascular risk in a mixed urban and rural population in Russia.Methods:This is a prospective multicenter cohort study including 3249 individuals with high cardiovascular risk (mean age 56 ± 12.8 years) from the larger Moscow region who were screened for AF using a smartphone-case based single-lead ECG monitor over a period of 18 month. The endpoints were considered as number of newly diagnosed AF; mean time to diagnosis; number of patients for the first time assigned to anticoagulation therapy; frequency of adverse events.Results:A trial fibrillation was diagnosed in 126 patients, 36 of them for the first time. The mean time to diagnosis was 3 ± 2 days. Of 36 patients, the CHA2DS2-VASc score was ≥1 in 34 cases, ≥2 in 29 cases. Anticoagulant therapy was first induced in 31 patients. One death in newly diagnosed group and two deaths in chronic group were registered. There were a total of eight hospitalizations: one in newly diagnosed and seven in chronic AF patients.Conclusion:Our results indicate that a Federal AF screening system in patients at high cardiovascular risk by using a smartphone-case based single lead ECG which is supported by centrally located ECG specialist and central data management is feasible and reliable when performed in a mixed urban and rural area. Further studies are needed to evaluate the full potential of this approach.
Highlights
Our results indicate that a Federal atrial fibrillation (AF) screening system in patients at high cardiovascular risk by using a smartphone-case based single lead ECG which is supported by centrally located ECG specialist and central data management is feasible and reliable when performed in a mixed urban and rural area
Given the severe consequences of ischemic strokes and a rather high mortality rate, timely screening is considered as the main mechanism to reduce the burden of AF by identification of asymptomatic forms of atrial fibrillation followed by the administration of adequate anticoagulation therapy
This study describes the first results in regard to applicability and results of such a system for AF screening and remote heart rhythm monitoring
Summary
The economic burden of atrial fibrillation in the Russian Federation is estimated to be about 52 billion rubles/year, and a further increase of up to 135 billion rubles/year is expected due to an increasing incidence rate and progress with the availability of invasive diagnostic and therapeutic interventions [1]. Given the severe consequences of ischemic strokes and a rather high mortality rate, timely screening is considered as the main mechanism to reduce the burden of AF by identification of asymptomatic forms of atrial fibrillation followed by the administration of adequate anticoagulation therapy. At the same time such patient has a high risk of developing atrial fibrillation. These patients, especially not in the central regions, cannot always get timely access to medical care. Questions in regard to how to screen, on whom to screen, and the optimal setting of screening remain unanswered
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