Subclinical Atrial Fibrillation in Older Patients
Key result
Continuous ECG monitoring detects subclinical AF in ~34% of older at-risk patients annually.
- 95% CI 27.7-42.3
- n=256
Population
256 patients ≥65 years of age attending cardiovascular or neurology outpatient clinics with no history of…
Design
Cohort
Follow-up
16.3±3.8 months
Authors
Discussion
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Implication
High subclinical AF incidence in older high-risk outpatients; hypothesis-generating for screening trials before practice change.
Study Design
Type
Cohort (n=256)
Multicenter
Yes
Structured PICO
P
Population
256 patients ≥65 years of age attending cardiovascular or neurology outpatient clinics with no history of atrial fibrillation, but with CHA2DS2-VASc score ≥2, sleep apnea, or body mass index >30 kg/m2, and either left atrial enlargement (≥4.4 cm or volume ≥58 mL) or increased serum NT-proBNP (≥290 pg/mL). Mean age 74±6 years, 48% had prior stroke, transient ischemic attack, or systemic embolism.
I
Intervention
Implantation of subcutaneous electrocardiographic monitors (St. Jude CONFIRM-AF) for continuous monitoring
O
Outcome
Detection of subclinical atrial fibrillation (SCAF) lasting ≥5 minutessurrogate
Continuous electrocardiographic monitoring detects a high rate of subclinical atrial fibrillation (34.4%/year) in older, high-risk outpatients without a prior history of the arrhythmia.
Limitations
- Included nonconsecutive outpatients meeting specific eligibility criteria, not representative of the general population.
- Not designed to determine the stroke risk associated with subclinical atrial fibrillation.
- Modest statistical power to compare subgroups of patients.
- Did not perform remote monitoring, which may have led to saturated device counters and a modest underestimation of SCAF burden.
Cite This Study
Healey et al. (2017) conducted a cohort in Patients at risk for subclinical atrial fibrillation (n=256). Subcutaneous implantable cardiac monitor (St. Jude CONFIRM-AF) was evaluated on Device-detected subclinical atrial fibrillation lasting ≥5 minutes (95% CI 27.7-42.3). Continuous electrocardiographic monitoring detected subclinical atrial fibrillation lasting ≥5 minutes at a rate of 34.4% per year in older patients with cardiovascular risk factors.