Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: VITAL-AF Randomized Controlled Trial

• Main Authors: Ashburner, J.M (Author), Atlas, S.J (Author), Borowsky, L.H (Author), Chang, Y. (Author), Ellinor, P.T (Author), Guan, W. (Author), Khurshid, S. (Author), Lipsanopoulos, A.T.T (Author), Lubitz, S.A (Author), McManus, D.D (Author), Singer, D.E (Author)
• Format: Article
• Language: English
• Published: Lippincott Williams and Wilkins 2022
• Subjects: accuracy; acute heart infarction; adult; aged; algorithm; anthropometry; anticoagulant agent; apixaban; Article; atrial fibrillation; attributable risk; body height; body weight; cerebrovascular accident; CHA2DS2-VASc score; clinical assessment; clinical evaluation; cluster analysis; Cohorts for Aging and Research in Genomic Epidemiology Atrial Fibrillation; comparative study; controlled study; coronary artery disease; dabigatran; data completeness; diabetes mellitus; diagnostic accuracy; diastolic blood pressure; digital health; edoxaban; electrocardiogram; electrocardiography; electronic medical record; evaluation and follow up; female; health service; heart auscultation; heart failure; heart rhythm; human; hypertension; ICD-10; incidence; intention to treat analysis; intervention study; major clinical study; male; medical assistant; middle aged; oscillometry; outcome assessment; outpatient department; oxygen saturation; point of care testing; post hoc analysis; practice guideline; primary medical care; propensity score; pulse rate; randomized controlled trial; research; rivaroxaban; screening; Screening for Atrial Fibrillation in the Elderly; sensitivity analysis; systolic blood pressure; vascular disease; very elderly; warfarin
• Online Access: View Fulltext in Publisher
• Physical Description: 9
• ISBN: 00097322 (ISSN)
• DOI: 10.1161/CIRCULATIONAHA.121.057014

Background: Undiagnosed atrial fibrillation AF may cause preventable strokes. Guidelines differ regarding AF screening recommendations. We tested whether point-of-care screening with a handheld single-lead ECG at primary care practice visits increases diagnoses of AF. Methods: We randomized 16 primary care clinics 1:1 to AF screening using a handheld single-lead ECG AliveCor KardiaMobile during vital sign assessments, or usual care. Patients included were ages ≥65 years. Screening results were provided to primary care clinicians at the encounter. All confirmatory diagnostic testing and treatment decisions were made by the primary care clinician. New AF diagnoses during the 1-year follow-up were ascertained electronically and manually adjudicated. Proportions and incidence rates were calculated. Effect heterogeneity was assessed. Results: Of 30 715 patients without prevalent AF n=15 393 screening [91% screened], n=15 322 control, 1.72% of individuals in the screening group had new AF diagnosed at 1 year versus 1.59% in the control group risk difference, 0.13% [95% CI, -0.16 to 0.42]; P=0.38. In prespecified subgroup analyses, new AF diagnoses in the screening and control groups were greater among those aged ≥85 years 5.56% versus 3.76%, respectively; risk difference, 1.80% [95% CI, 0.18 to 3.30]. The difference in newly diagnosed AF between the screening period and the previous year was marginally greater in the screening versus control group 0.32% versus -0.12%; risk difference, 0.43% [95% CI, -0.01 to 0.84]. The proportion of individuals with newly diagnosed AF who were initiated on oral anticoagulants was not different in the screening n=194, 73.5% and control n=172, 70.8% arms risk difference, 2.7% [95% CI, -5.5 to 10.4]. Conclusions: Screening for AF using a single-lead ECG at primary care visits did not affect new AF diagnoses among all individuals aged 65 years or older compared with usual care. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03515057. © 2022 American Heart Association, Inc.