Screen-detected atrial fibrillation predicts mortality in elderly subjects

Matthias D. Zink; Karl G. Mischke; Andras P. Keszei; Christian Rummey; Ben Freedman; Gabriele Neumann; Alina Tolksdorf; Friederike Frank; Jan Wienstroeer; Nicole Kuth; Joerg B. Schulz; Nikolaus Marx

doi:10.1093/europace/euaa190

Screen-detected atrial fibrillation predicts mortality in elderly subjects

Matthias D. Zink, Karl G. Mischke, Andras P. Keszei, Christian Rummey, Ben Freedman, Gabriele Neumann, Alina Tolksdorf, Friederike Frank, Jan Wienstroeer, Nicole Kuth, Joerg B. Schulz, Nikolaus Marx^*

^*Corresponding author for this work

Carim - Experimental atrial fibrillation

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Aims Current guidelines recommend opportunistic screening for atrial fibrillation (AF) but the prognosis of individuals is unclear. The aim of this investigation is to determine prevalence and 1-year outcome of individuals with screen-detected AF.

Methods and results We performed a prospective, pharmacy-based single time point AF screening study in 7107 elderly citizens (>= 65 years) using a hand-held, single-lead electrocardiogram (ECG) device. Prevalence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Mean age of participants was 74 +/- 5.9 years, with 58% (N = 4130) of female sex. Automated heart rhythm analyses identified AF in 432 (6.1%) participants, with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalized for CV causes. Total mortality was 2.3% in participants with a screen-detected AF and 0.8% in subjects with a normal ECG [hazard ratio (HR) 2.94; 95% confidence interval (CI) 1.49-5.78; P= 0.002]; hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI 1.52-2.84; P< 0.001). Compared with subjects without a history of AF at baseline and a normal ECG, participants with newly diagnosed or known AF had a significantly higher mortality risk with HRs of 2.64 (95% CI 1.05-6.66; P= 0.04) and 2.68 (95% CI 1.44-4.97; P= 0.002), respectively. After multivariable adjustment, screen-detected AF remained a significant predictor of death or hospitalization for CV causes.

Conclusion Pharmacy-based, automated AF screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next year.

[GRAPHICS]

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Original language	English
Pages (from-to)	29-38
Number of pages	10
Journal	EP Europace
Volume	23
Issue number	1
DOIs	https://doi.org/10.1093/europace/euaa190
Publication status	Published - Jan 2021

Keywords

Atrial fibrillation
Opportunistic
Outcome
Pharmacy
Prognosis
Screening
COMMUNITY
IPHONE ECG
STROKE PREVENTION
PHARMACIES
DEVICE
RISK

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10.1093/europace/euaa190Licence: CC BY-NC

Cite this

@article{6c8367583ea142879c6fef8cfd304250,

title = "Screen-detected atrial fibrillation predicts mortality in elderly subjects",

abstract = "Aims Current guidelines recommend opportunistic screening for atrial fibrillation (AF) but the prognosis of individuals is unclear. The aim of this investigation is to determine prevalence and 1-year outcome of individuals with screen-detected AF.Methods and results We performed a prospective, pharmacy-based single time point AF screening study in 7107 elderly citizens (>= 65 years) using a hand-held, single-lead electrocardiogram (ECG) device. Prevalence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Mean age of participants was 74 +/- 5.9 years, with 58% (N = 4130) of female sex. Automated heart rhythm analyses identified AF in 432 (6.1%) participants, with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalized for CV causes. Total mortality was 2.3% in participants with a screen-detected AF and 0.8% in subjects with a normal ECG [hazard ratio (HR) 2.94; 95% confidence interval (CI) 1.49-5.78; P= 0.002]; hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI 1.52-2.84; P< 0.001). Compared with subjects without a history of AF at baseline and a normal ECG, participants with newly diagnosed or known AF had a significantly higher mortality risk with HRs of 2.64 (95% CI 1.05-6.66; P= 0.04) and 2.68 (95% CI 1.44-4.97; P= 0.002), respectively. After multivariable adjustment, screen-detected AF remained a significant predictor of death or hospitalization for CV causes.Conclusion Pharmacy-based, automated AF screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next year.[GRAPHICS].",

keywords = "Atrial fibrillation, Opportunistic, Outcome, Pharmacy, Prognosis, Screening, COMMUNITY, IPHONE ECG, STROKE PREVENTION, PHARMACIES, DEVICE, RISK",

author = "Zink, {Matthias D.} and Mischke, {Karl G.} and Keszei, {Andras P.} and Christian Rummey and Ben Freedman and Gabriele Neumann and Alina Tolksdorf and Friederike Frank and Jan Wienstroeer and Nicole Kuth and Schulz, {Joerg B.} and Nikolaus Marx",

note = "Publisher Copyright: {\textcopyright} 2020 The Author(s).",

year = "2021",

month = jan,

doi = "10.1093/europace/euaa190",

language = "English",

volume = "23",

pages = "29--38",

journal = "EP Europace",

issn = "1099-5129",

publisher = "Oxford University Press",

number = "1",

}

TY - JOUR

T1 - Screen-detected atrial fibrillation predicts mortality in elderly subjects

AU - Zink, Matthias D.

AU - Mischke, Karl G.

AU - Keszei, Andras P.

AU - Rummey, Christian

AU - Freedman, Ben

AU - Neumann, Gabriele

AU - Tolksdorf, Alina

AU - Frank, Friederike

AU - Wienstroeer, Jan

AU - Kuth, Nicole

AU - Schulz, Joerg B.

AU - Marx, Nikolaus

PY - 2021/1

Y1 - 2021/1

N2 - Aims Current guidelines recommend opportunistic screening for atrial fibrillation (AF) but the prognosis of individuals is unclear. The aim of this investigation is to determine prevalence and 1-year outcome of individuals with screen-detected AF.Methods and results We performed a prospective, pharmacy-based single time point AF screening study in 7107 elderly citizens (>= 65 years) using a hand-held, single-lead electrocardiogram (ECG) device. Prevalence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Mean age of participants was 74 +/- 5.9 years, with 58% (N = 4130) of female sex. Automated heart rhythm analyses identified AF in 432 (6.1%) participants, with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalized for CV causes. Total mortality was 2.3% in participants with a screen-detected AF and 0.8% in subjects with a normal ECG [hazard ratio (HR) 2.94; 95% confidence interval (CI) 1.49-5.78; P= 0.002]; hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI 1.52-2.84; P< 0.001). Compared with subjects without a history of AF at baseline and a normal ECG, participants with newly diagnosed or known AF had a significantly higher mortality risk with HRs of 2.64 (95% CI 1.05-6.66; P= 0.04) and 2.68 (95% CI 1.44-4.97; P= 0.002), respectively. After multivariable adjustment, screen-detected AF remained a significant predictor of death or hospitalization for CV causes.Conclusion Pharmacy-based, automated AF screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next year.[GRAPHICS].

AB - Aims Current guidelines recommend opportunistic screening for atrial fibrillation (AF) but the prognosis of individuals is unclear. The aim of this investigation is to determine prevalence and 1-year outcome of individuals with screen-detected AF.Methods and results We performed a prospective, pharmacy-based single time point AF screening study in 7107 elderly citizens (>= 65 years) using a hand-held, single-lead electrocardiogram (ECG) device. Prevalence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Mean age of participants was 74 +/- 5.9 years, with 58% (N = 4130) of female sex. Automated heart rhythm analyses identified AF in 432 (6.1%) participants, with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalized for CV causes. Total mortality was 2.3% in participants with a screen-detected AF and 0.8% in subjects with a normal ECG [hazard ratio (HR) 2.94; 95% confidence interval (CI) 1.49-5.78; P= 0.002]; hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI 1.52-2.84; P< 0.001). Compared with subjects without a history of AF at baseline and a normal ECG, participants with newly diagnosed or known AF had a significantly higher mortality risk with HRs of 2.64 (95% CI 1.05-6.66; P= 0.04) and 2.68 (95% CI 1.44-4.97; P= 0.002), respectively. After multivariable adjustment, screen-detected AF remained a significant predictor of death or hospitalization for CV causes.Conclusion Pharmacy-based, automated AF screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next year.[GRAPHICS].

KW - Atrial fibrillation

KW - Opportunistic

KW - Outcome

KW - Pharmacy

KW - Prognosis

KW - Screening

KW - COMMUNITY

KW - IPHONE ECG

KW - STROKE PREVENTION

KW - PHARMACIES

KW - DEVICE

KW - RISK

U2 - 10.1093/europace/euaa190

DO - 10.1093/europace/euaa190

M3 - Article

C2 - 33020819

SN - 1099-5129

VL - 23

SP - 29

EP - 38

JO - EP Europace

JF - EP Europace

IS - 1

ER -