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February 24, 2021

Screening the Older Population for Atrial Fibrillation—Have We Moved the Needle Forward?

Author Affiliations
  • 1Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, California
JAMA Cardiol. 2021;6(5):495-496. doi:10.1001/jamacardio.2021.0052

In this issue of JAMA Cardiology, Gladstone and colleagues1 report the results of a multicenter, open-label, randomized clinical trial of screening high-risk older individuals for asymptomatic atrial fibrillation (AF). This study investigated a standard care approach of pulse palpation and auscultation in the clinic setting (baseline and 6 months) compared with a 2-week continuous electrocardiographic (cECG) patch monitor (baseline and 3 months) in addition to standard care. The primary outcome was AF or atrial flutter (≥1 episode lasting >5 minutes with cECG monitoring or diagnosed clinically by 12-lead ECG) detected within 6 months. The investigators enrolled 856 participants aged 75 years or older with hypertension requiring antihypertensive medication (median CHA2DS2-VASc score, 4) and no history of AF who were recruited from 48 primary care clinics in Canada and Germany. The secondary outcome was oral anticoagulant (OAC) use at 6 months, and additional outcomes included clinical events, health care use, AF detection by a home blood pressure monitor used twice-daily during the period of patch monitoring, detection of other arrhythmias, and patch adherence. The key findings were (1) a screening approach with cECG patch monitoring yielded a 10-fold higher increase in AF detection rate compared with standard care, (2) most AF was paroxysmal (median, 6.3 hours) and detected during the first patch monitoring after 24 hours, and (3) 75.0% of patients with AF detected during patch monitoring had initiation of OAC therapy.

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