Abstract
The rising numbers of people with atrial fibrillation (AF) carry a heavy toll on our graying population. Epidemiological data suggest that AF exists in 1 in 10 individuals aged older than 80 years. The risk of embolic stroke increases along with well-known cardiovascular risk factors. Should there be systematic screening for the elderly? Although 1 in 10 is a huge hit rate in screening for any major illness, the initiative for such programs in AF remains in ‘research and development’.At present, cardiologists can utilize implantable loop recorders in patients referred for specialist consultation. Novel technologies are also available, including cloud-based, algorithm-assisted, non-invasive monitoring patches, which allow extended observation periods.What about people in the community without a recognized need for cardiologic investigation? Mobile technology has made detection of pulse irregularity possible without medical attention. Smartphone apps enable opportunistic rhythm monitoring, but true arrhythmias need to be medically verified. AF may be the first common disorder to be effectively screened for by mobile technology. In the spirit of proactive campaigns such as ‘Know Your Pulse’, we should prepare for rapidly increasing reports of various pulse irregularities.
Highlights
The rising numbers of people with atrial fibrillation (AF) carry a heavy toll on our graying population
We believe that more aggressive societal programs and technological innovations in self-administered AF detection could lead to a reduced burden of embolic strokes in the face of the AF epidemic related to the ‘graying’ of western civilization
One study found that pulse palpation by a practice nurse plus 12-lead ECG reading by a general practitioner is an efficient means of screening older patients for AF [16]
Summary
AF is common, affecting approximately 5% of adults aged 65 years and older, and 10% of those older than 80 years [3]. AF increases the risk for ischemic stroke by approximately fivefold. In the UK, findings from the SAFE study [6] showed a baseline prevalence of AF of 7.2% in patients aged 65 years and older, with an increased prevalence in men (7.8%). In those aged 75 years and older (10.3%), and a yearly incidence of new AF of about 1.6%. AF causes 15% of all strokes, and 30% of those whose strokes occur after the age of 80 years in the US population [3,4]. 5-year hospital costs after stroke were $25,741 [7], but the lifetime costs have been estimated to be substantially higher; for example, $130,000 after ischemic stroke in Finland [8]
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