In the cluster randomised VITAL-AF trial, screening patients during primary care visits using a single-lead ECG was feasible but not associated with a significant increase in new atrial fibrillation (AF) diagnoses compared with usual care . However, it may be useful in patients aged ≥85 years.
Dr Steven Lubitz (Massachusetts General Hospital, USA) said screening in primary care might be optimal because it can identify people who might benefit from treatment at a large scale and enable efficient treatment initiation. In VITAL-AF (NCT03515057), patients aged ≥65 years from 16 hospital- and community-based practices were randomised 1:1 to usual care or AF screening, using an AliveCor single-lead ECG, during routine visits. The primary endpoint was the rate of newly diagnosed AF over a period of 12 months. A total of 30,722 patients were included.
In the intervention arm, 91% of participants (n=15,397) were screened compared with only 2% of participants in the control group (n=15,325). However, the rate of newly diagnosed AF was not significantly different: 1.74% versus 1.60%, respectively (P=0.33). In patients aged ≥85 years, screening yielded more new diagnosed patients, with an absolute risk difference of 1.88% (number-needed-to-screen: 53).
“Screening all individuals aged 65 or older is not a highly effective way to detect undiagnosed AF, in a practice that resembles ours,” Dr Lubitz concluded. “However, screening older individuals who are at high risk of AF, especially those 85 years and older, may be effective.”
- Lubitz S, et al. Screening for Atrial Fibrillation in Older Adults at Primary Care Visits Using Single Lead Electrocardiograms: The VITAL-AF Trial. LBS.06, AHA Scientific Sessions 2020, 13–17 Nov.
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