基层保健护士使用智能手机心电图(iECG)在流感疫苗接种期间筛查心房颤动：一项可行性研究。

Screening for atrial fibrillation during influenza vaccinations by primary care nurses using a smartphone electrocardiograph (iECG): A feasibility study.

机构信息

Sydney Nursing School, Charles Perkins Centre, University of Sydney, Australia

Sydney Medical School, University of Sydney, Australia.

出版信息

Eur J Prev Cardiol. 2016 Oct;23(2 suppl):13-20. doi: 10.1177/2047487316670255.

DOI:10.1177/2047487316670255

PMID:27892421

Abstract

BACKGROUND

People with unknown atrial fibrillation (AF), who are often asymptomatic, have a substantially increased risk of stroke. Although recommended in European guidelines, AF screening is not routinely performed. Screening at the time of influenza vaccination presents an ideal opportunity to detect AF in large numbers in a primary care medical setting, with an existing annual recall system for patients aged ≥65 years.

DESIGN

Cross-sectional pilot study of handheld smartphone electrocardiogram (iECG) screening to identify unknown AF.

METHODS

General practices in Sydney, Australia, were recruited during the influenza-vaccination period of April-June 2015. Practice nurses screened patients aged ≥65 years with a 30-second iECG, which has a validated algorithm for detecting AF in real time. In order to confirm the accuracy of the algorithm, two research cardiologists reviewed de-identified iECGs. In order to explore barriers and enablers, semi-structured interviews were conducted with selected nurses, practice managers and general practitioners.

RESULTS

Five general practices were recruited, and 973/2476 (39%) patients attending influenza vaccination were screened. Screening took an average of 5 minutes (range 1.5-10 minutes); however, abnormal iECGs required additional time. Newly identified AF was found in 8/973 patients (0.8%). The sensitivity of the iECG automated algorithm was 95% (95% confidence interval: 83-99%) and the specificity was 99% (95% confidence interval: 98-100%). Screening by practice nurses was well accepted by practice staff. Key enablers were the confidence and competence of nurses and a 'designated champion' to lead screening at the practice. Barriers were practice specific, and mainly related to staff time and funding.

CONCLUSIONS

Screening with iECG during influenza vaccination by primary care nurses is feasible and well accepted by practice staff. Addressing barriers is likely to increase uptake.

摘要

背景

患有不明原因房颤（AF）的患者通常没有症状，但发生中风的风险显著增加。尽管欧洲指南推荐进行房颤筛查，但并未常规开展。在流感疫苗接种时进行筛查，为在初级保健医疗环境中发现大量房颤患者提供了理想机会，同时为≥65 岁的患者建立了现有的年度召回系统。

设计

使用手持式智能手机心电图（iECG）进行横断面试点研究，以确定未知的房颤。

方法

在 2015 年 4 月至 6 月流感疫苗接种期间，澳大利亚悉尼的全科诊所被招募参加研究。执业护士使用 30 秒 iECG 对≥65 岁的患者进行筛查，该设备具有实时检测房颤的经过验证的算法。为了确认算法的准确性，两名研究心脏病专家对匿名 iECG 进行了审查。为了探索障碍和促进因素，对选定的护士、执业经理和全科医生进行了半结构式访谈。

结果

共招募了 5 家全科诊所，对 2476 名参加流感疫苗接种的患者中的 973 名进行了筛查。筛查平均耗时 5 分钟（范围 1.5-10 分钟）；但是，异常的 iECG 需要额外的时间。在 8/973 名患者（0.8%）中发现了新的房颤。iECG 自动算法的灵敏度为 95%（95%置信区间：83-99%），特异性为 99%（95%置信区间：98-100%）。由执业护士进行的筛查得到了执业人员的认可。关键的促进因素是护士的信心和能力，以及一名在执业中领导筛查的“指定负责人”。障碍是具体实践相关的，主要与员工时间和资金有关。