The feasibility of population screening for paroxysmal atrial fibrillation using hand-held electrocardiogram devices.

There are few data on the feasibility of population screening for paroxysmal atrial fibrillation (AF) using hand-held electrocardiogram (ECG) devices outside a specialist setting or in people over the age of 75. We investigated the feasibility of screening when conducted without face-to-face contact ('remote') or via in-person appointments in primary care and explored impact of age on screening outcomes. People aged ≥65 years from 13 general practices in England participated in screening during 2019-20. This involved attending a practice nurse appointment (10 practices) or receiving an ECG device by post (three practices). Participants were asked to use a hand-held ECG for 1-4 weeks. Screening outcomes included uptake, quality of ECGs, AF detection rates, and uptake of anticoagulation if AF was detected. Screening was carried out by 2141 (87.5%) of people invited to practice nurse-led screening and by 288 (90.0%) invited to remote screening. At least 56 interpretable ECGs were provided by 98.0% of participants who participated for 3 weeks, with no significant differences by setting or age, except people aged 85 or over (91.1%). Overall, 2.6% (64/2429) screened participants had AF, with detection rising with age (9.2% in people aged 85 or over). A total of 53/64 (82.8%) people with AF commenced anticoagulation. Uptake of anticoagulation did not vary by age. Population screening for paroxysmal AF is feasible in general practice and without face-to-face contact for all ages over 64 years, including people aged 85 and over.

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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.

Déclaration de conflit d'intérêts

Conflict of interest: All authors are undertaking the SAFER study named in the paper. J.M. has performed consultancy work for BMS/Pfizer and Omron. F.D.R.H. reports occasional consultancy for BMS/Pfizer, Bayer, and BI over the last 5 years. G.Y.H.L. is a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi Sankyo, and Anthos. No fees are received personally. S.J.G. has received honoraria from AstraZeneca for lecturing at postgraduate educational meetings for primary care teams about type 2 diabetes. B.F. has received speaker fees, honoraria, and non-financial support from BMS and Pfizer Alliance and loan devices for investigator-initiated studies from AliveCor: all were unrelated to the present study but related to screening for AF. P.C. has performed consultancy work for Cambridge University Technical Services and has received honoraria from IOP Publishing and Emory University (the latter not received personally). All remaining authors have declared no conflict of interest.