Screening for atrial fibrillation in hospitalised geriatric patients.
Heart. 2017 Sep 07;:
Authors: Tavernier R, Wolf M, Kataria V, Phlips T, Huys R, Taghji P, Louw R, Hoeyweghen RV, Vandekerckhove Y, Knecht S, Duytschaever M
OBJECTIVES: To assess whether daily short-term rhythm strip recordings on top of routine clinical care could increase the atrial fibrillation (AF) detection rate in the hospitalised elderly.
METHODS: A hand-held device storing a bipolar ECG during 1 min was used for daily rhythm recording in hospitalised elderly patients.
RESULTS: During 2 months, all patients admitted to the Department of Geriatric Medicine were screened (n=327). Five patients refused to participate in the study and 70 patients were unable to hold the device due to severe mental (n=46) or motor impairment (n=24). In the remaining 252 patients, 1582 recordings were successfully obtained after 1624 attempts with a median acquisition time of 1 min (min 1, max 9, IQR 1-2 min). The rhythm strips were not reliable interpretable due to artefacts in three patients or an implantable cardiac pulse generator in another 28 patients. Detailed clinical information was available in 214/221 patients. Mean age was 84±6 years. On top of 71 (33%) patients with AF identified by routine clinical care (history, n=64 or de novo detected during current hospitalisation, n=7), review of all rhythm strips identified another 28 patients (13%) with AF. All these patients had a CHA2DS2VASc score ≥2. A contraindication for anticoagulation was present in only 8/28 (25%) of identified patients.
CONCLUSIONS: On top of routine clinical care, daily short-term rhythm strip recordings identified another 13% of elderly hospitalised patients with AF, leading to an overall prevalence of 46% in hospitalised patients. This can have significant therapeutic implications with respect to initiation of anticoagulation.
PMID: 28883032 [PubMed - as supplied by publisher]