June 6, 2022PLoS ONEOpen Access

Screening for untreated atrial fibrillation in the elderly population: A community-based study

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Why the study?

Community-based studies on screening for untreated AF had not been conducted in Japan, and the effectiveness of early AF screening in the elderly was unassessed.

Does community-based screening using a BP monitor with ECG detect untreated AF and improve modeled QALYs in the elderly population?

Structured PICO

Does community-based screening using a BP monitor with ECG detect untreated AF and improve modeled QALYs in the elderly population?

Population

1,607 elderly individuals (≥65 years) from a community in Japan, mean age 72.4±5.8 years, 51.5% female, 39.1% with hypertension, and 85.1% with CHA2DS2-VASc score ≥2.

Intervention

Community-based AF screening using a blood pressure monitor with ECG (the Complete, Omron) and educational lectures, combined with a Markov model evaluating DOAC treatment for detected AF.

Comparator

No screening / untreated AF (in the modeled analysis).

Outcome

Detection rate of new AF and modeled life-years and QALYs (quality-adjusted life-years) gained with DOAC treatment.surrogate

Community-based screening using an ECG-equipped blood pressure monitor identified previously untreated AF in 0.93% of elderly individuals, which modeling suggests could provide meaningful gains in quality-adjusted life-years if treated with DOACs.

Implication

Community screening detected untreated AF in 0.93% of Japanese elderly; supports prospective trials before routine adoption.

Abstract

BACKGROUND: Strokes are common in people with atrial fibrillation (AF), and can have devastating consequences, especially in the elderly and if AF is untreated. However, community-based studies on screening for untreated AF have not been conducted in Japan, and there has been no evaluation of the effectiveness of early screening for AF in the elderly (≥65 years). METHODS: The Kyoto Prefectural University of Medicine (KPUM) Education Initiative has conducted an AF awareness campaign consisted of screening tests using a blood pressure (BP) monitor with electrocardiogram (ECG) (the Complete, Omron Healthcare Co., Ltd., Kyoto, Japan) and educational lectures for the elderly (≥65 years) from 2019 to 2020. A modeled effectiveness analysis was performed comparing the life-years and QALYs (quality-adjusted life-years) between direct-acting oral anticoagulation (DOAC)-treated AF and untreated AF in a Japanese setting. The basic description of the Markov model was used for the analysis. RESULTS: A total of 1648 participants were screened, and after excluding those with missing information or data (n = 41), 1607 were finally enrolled. The mean (± standard deviation) age of participants was 72.4±5.8 years, 827 (51.5%) were female, 628 (39.1%) had hypertension, and 1368 (85.1%) had CHA2DS2-VASc score ≥2. After cardiologists' evaluation of all ECG recordings of the Complete, 15 (0.93%) AF were newly detected. For each AF treated with DOAC, 0.859 QALYs gained over the lifetime for 65 years-old men, and 0.856 QALYs for 65 years-old women compared to non-treatment. CONCLUSION: A moderate number of untreated AF were identified in the community-based study. Identification of an increased number of patients with AF, if properly treated with DOAC, ultimately leads to a reduction in the number of strokes occurred over subjects' lifetime.