Key result
Screen-detected AF linked to ~194% higher 1-year mortality vs normal ECG.
Why the study?
Current guidelines recommend opportunistic screening for AF, but the prognosis of individuals identified by screening is unclear.
Does pharmacy-based single-lead ECG screening for atrial fibrillation predict mortality and cardiovascular hospitalization in elderly subjects?
Cohort (n=7,107)
Yes
Does pharmacy-based single-lead ECG screening for atrial fibrillation predict mortality and cardiovascular hospitalization in elderly subjects?
Hazard Ratio: 2.94 (95% CI 1.49–5.78)
Absolute Event Rate: 2.3% vs 0.8%
p-value: p=0.002
Pharmacy-based, automated 1-minute single-lead ECG screening in elderly citizens effectively identifies individuals with unknown atrial fibrillation who face a significantly increased 1-year risk of all-cause mortality and cardiovascular hospitalization.
Screen-detected AF marks higher short-term mortality risk in elderly; leaves open whether screening improves outcomes.
AIMS: Current guidelines recommend opportunistic screening for atrial fibrillation (AF) but the prognosis of individuals is unclear. The aim of this investigation is to determine prevalence and 1-year outcome of individuals with screen-detected AF. METHODS AND RESULTS: We performed a prospective, pharmacy-based single time point AF screening study in 7107 elderly citizens (≥65 years) using a hand-held, single-lead electrocardiogram (ECG) device. Prevalence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Mean age of participants was 74 ± 5.9 years, with 58% (N = 4130) of female sex. Automated heart rhythm analyses identified AF in 432 (6.1%) participants, with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalized for CV causes. Total mortality was 2.3% in participants with a screen-detected AF and 0.8% in subjects with a normal ECG [hazard ratio (HR) 2.94; 95% confidence interval (CI) 1.49-5.78; P = 0.002]; hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI 1.52-2.84; P < 0.001). Compared with subjects without a history of AF at baseline and a normal ECG, participants with newly diagnosed or known AF had a significantly higher mortality risk with HRs of 2.64 (95% CI 1.05-6.66; P = 0.04) and 2.68 (95% CI 1.44-4.97; P = 0.002), respectively. After multivariable adjustment, screen-detected AF remained a significant predictor of death or hospitalization for CV causes. CONCLUSION: Pharmacy-based, automated AF screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next year.
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Zink et al. (2020) conducted a cohort in Atrial fibrillation (n=7,107). Screen-detected atrial fibrillation vs. Normal ECG was evaluated on All-cause mortality (HR 2.94, 95% CI 1.49-5.78, p=0.002). Screen-detected atrial fibrillation in elderly citizens was associated with a significantly higher 1-year all-cause mortality risk compared to a normal ECG (HR 2.94).