Screening for Atrial Fibrillation in the Older Population
Key result
Home-based AF screening with a wearable cECG monitor increased AF detection at 6 months compared to standard care (5.3% vs 0.5%; RR 11.2; 95% CI 2.7-47.1; P=.001).
Why the study?
Atrial fibrillation is a major cause of preventable strokes, and screening asymptomatic individuals may increase anticoagulant use for stroke prevention.
Does a screening strategy using a 2-week continuous ECG patch monitor and home BP monitor increase atrial fibrillation detection in older individuals with hypertension compared to standard care?
Population
856 individuals aged 75 years or older with hypertension and without known AF
Comparison
Home-based cECG patch and oscillometric BP screening plus standard care vs standard care alone
Design
Multicenter randomized clinical trial
Follow-up
6 months
Authors
Discussion
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Implication
Home cECG screening increases AF detection and anticoagulation in older hypertensives; extends evidence for targeted screening but leaves stroke outcomes unproven.
Key Points
- To evaluate the efficacy of home-based continuous electrocardiographic patch monitoring and oscillometric blood pressure screening for detecting atrial fibrillation in older individuals with hypertension.
- Multicenter randomized clinical trial enrolling 856 participants aged 75 years or older with hypertension and without known atrial fibrillation across 48 primary care practices (NCT02392754).
- Participants were assigned to standard care alone or standard care combined with two 2-week continuous electrocardiographic (cECG) patch monitoring periods and twice-daily oscillometric blood pressure screening over 6 months.
- Atrial fibrillation was detected in 23 of 434 participants (5.3%) in the screening group versus 2 of 422 (0.5%) in the control group (RR, 11.2; 95% CI, 2.7-47.1; P = .001; absolute difference, 4.8%; 95% CI, 2.6%-7.0%; P < .001).
- Anticoagulation therapy was prescribed by 6 months for 18 of 434 participants (4.1%) in the screening group compared with 4 of 422 (0.9%) in the control group (RR, 4.4; 95% CI, 1.5-12.8; P = .007; absolute difference, 3.2%; 95% CI, 1.1%-5.3%; P = .003).
- Twice-daily home blood pressure monitor screening achieved a sensitivity of 35.0% (95% CI, 15.4%-59.2%) and a specificity of 81.0% (95% CI, 76.7%-84.8%) for detecting atrial fibrillation.
Study Design
Type
RCT (n=856)
Multicenter
Yes
Structured PICO
Does a screening strategy using a 2-week continuous ECG patch monitor and home BP monitor increase atrial fibrillation detection in older individuals with hypertension compared to standard care?
P
Population
856 individuals aged 75 years or older with hypertension and without known atrial fibrillation, followed for 6 months.
I
Intervention
2-week continuous electrocardiographic (cECG) patch monitor worn at baseline and at 3 months, plus automated home blood pressure (BP) machines with oscillometric AF screening capability used twice-daily during the cECG monitoring periods, in addition to standard care.
C
Comparator
Standard care (routine clinical follow-up plus a pulse check and heart auscultation at baseline and 6 months).
O
Outcome
Atrial fibrillation (AF) detected by cECG monitoring or clinically within 6 months.surrogate
Main Result
Relative Risk: 11.2 (95% CI 2.7–47.1)
Absolute Event Rate: 5.3% vs 0.5%
Absolute Risk Reduction: 4.8%
Number Needed to Treat: 21
p-value: p=.001
Screening with a wearable continuous ECG monitor significantly increased the detection of atrial fibrillation and prompted initiation of anticoagulant therapy in older adults with hypertension.
Cite This Study
Gladstone et al. (2021) conducted an RCT in Hypertension without known atrial fibrillation (n=856). Home-based AF screening with a 2-week continuous ECG patch monitor and automated home BP machines vs. Standard care (routine clinical follow-up plus pulse check and heart auscultation) was evaluated on Atrial fibrillation detected by cECG monitoring or clinically within 6 months (RR 11.2, 95% CI 2.7-47.1, p=.001). Home-based AF screening with a wearable cECG monitor increased AF detection at 6 months compared to standard care (5.3% vs 0.5%; RR 11.2; 95% CI 2.7-47.1; P=.001).