Key result
Portable 12-lead ECG screening detects AF in ~0.8% of older adults in community Nepal.
Why the study?
Many patients with AF remain undetected and undiagnosed despite risk of cardioembolic stroke, making screening and timely anticoagulation initiation essential to prevent complications.
Cross-Sectional (n=2,048)
No
This community-based screening in semiurban Nepal identified an atrial fibrillation prevalence of 0.78% among adults aged ≥50 years and revealed substantial underutilization of guideline-recommended oral anticoagulation (41.7%) among those at high risk of stroke.
Answers are grounded in this paper and cite their sources.
Highlights OAC underuse in high-risk AF; leaves open net benefit of one-time screening in similar low-resource settings.
Background: Atrial fibrillation (AF) is a common morbid arrhythmia that can cause thromboembolic events such as stroke. Despite advancements in diagnostic technologies, a significant number of AF patients may remain undetected and undiagnosed, and these asymptomatic patients possess sufficient risk of cardioembolic stroke. Identifying such patients through appropriate screening techniques and timely initiation of systemic anticoagulation therapy is essential to prevent such life‐threatening complications. Objectives: The objectives of this study encompass screening of AF among residents of the Dhulikhel Municipality and identifying its prevalence, along with evaluation of stroke risk and use of antithrombotic therapy in patients confirmed with AF. Methods: All residents of four wards of Dhulikhel Municipality, aged 50 years and above ( n = 2048), underwent one‐time electrocardiogram (ECG) screening using a portable 12‐lead ECG machine. The cardiologist checked the cardiogram, and suspected AF cases were referred to the hospital for further evaluation and appropriate management. They were followed up to find out information on disease confirmation and management. Results: Out of 2048 participants, AF was detected in 16 participants, resulting in an overall prevalence of 0.78% (CI 0.4%–1.3%). The prevalence of AF was highest (2.98%) in population aged 80 years and above. Among individuals with AF, the median age was 71.5 (66.3–79.5) years, 50.0% were male and 75.0% had high stroke risk as indicated by a CHA 2 DS 2 ‐VASc score ≥ 2. Among these patients, only 41.66% were treated with oral anticoagulants (OACs), while 58.34% were treated either with single or dual antiplatelet therapy (DAPT). Conclusion: This study provided important insight into the prevalence of AF at the community level. Many AF patients were at high risk of stroke, but the OAC use was less than 50%. Screening of AF needs to be carried out on a larger scale in Nepal for early detection and timely management of the disease.
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Shrestha et al. (2024) conducted a cross-sectional in Atrial fibrillation (n=2,048). One-time community screening using portable 12-lead ECG was evaluated on Prevalence of atrial fibrillation (95% CI 0.4%-1.3%). One-time portable 12-lead ECG screening detected atrial fibrillation in 0.78% of community residents aged ≥50 years in Nepal, with only 41.7% of high-stroke-risk patients receiving OACs.
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