Orchard Jessica, Freedman Saul Benedict, Lowres Nicole, Peiris David, Neubeck Lis
BEc/LLB (Hons I), MPH, Senior Project Officer, Cardiovascular Division, The George Institute for Global Health; and Adjunct Lecturer, Sydney Medical School, University of Sydney, NSW.
Aust Fam Physician. 2014 May;43(5):315-9.
Atrial fibrillation (AF) is often asymptomatic and substantially increases stroke risk. A single-lead iPhone electrocardiograph (iECG) with a validated AF algorithm could make systematic AF screening feasible in general practice.
A qualitative screening pilot study was conducted in three practices. Receptionists and practice nurses screened patients aged ≥65 years using an iECG (transmitted to a secure website) and general practitioner (GP) review was then provided during the patient's consultation. Fourteen semi-structured interviews with GPs, nurses, receptionists and patients were audio-recorded, transcribed and analysed thematically.
Eighty-eight patients (51% male; mean age 74.8 ± 8.8 years) were screened: 17 patients (19%) were in AF (all previously diagnosed). The iECG was well accepted by GPs, nurses and patients. Receptionists were reluctant, whereas nurses were confident in using the device, explaining and providing screening.
AF screening in general practice is feasible. A promising model is likely to be one delivered by a practice nurse, but depends on relevant contextual factors for each practice.
心房颤动（AF）通常无症状，但会大幅增加中风风险。一款具有经过验证的房颤算法的单导联苹果手机心电图仪（iECG）能够使在全科医疗中进行系统性房颤筛查成为可能。
在三家医疗机构开展了一项定性筛查试点研究。接待员和执业护士使用iECG（传输至一个安全网站）对65岁及以上患者进行筛查，然后在患者就诊期间由全科医生（GP）进行复查。对全科医生、护士、接待员和患者进行了14次半结构化访谈，并进行了录音、转录和主题分析。
共筛查了88名患者（51%为男性；平均年龄74.8±8.8岁）：17名患者（19%）患有房颤（均为既往已确诊）。iECG受到了全科医生、护士和患者的广泛接受。接待员不太愿意使用，而护士对使用该设备、解释并提供筛查充满信心。
在全科医疗中进行房颤筛查是可行的。一种有前景的模式可能是由执业护士来实施，但这取决于每家医疗机构的相关背景因素。
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