Karolinska Institute, Department of Clinical Sciences, Cardiology Unit, Danderyd Hospital, Stockholm, Sweden.
Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
PLoS One. 2018 May 24;13(5):e0198069. doi: 10.1371/journal.pone.0198069. eCollection 2018.
Atrial fibrillation (AF) is a major risk factor for ischemic stroke unless treated with an anticoagulant. Detecting AF can be difficult because AF is often paroxysmal and asymptomatic. The aims of this study were to develop a screening model to detect AF in a primary healthcare setting and to initiate oral anticoagulant therapy in high-risk patients to prevent stroke.
This was a cross-sectional study. All 70- to 74-year-old individuals registered at a single primary healthcare center in Stockholm were invited to participate in AF screening upon visiting the center during a ten-month period. Those who did not have contact with the center during this period were invited to participate by letter. Thirty-second intermittent ECG recordings were made twice a day using a handheld Zenicor device over a 2-week period in participants without AF. Oral anticoagulant therapy was offered to patients with newly detected AF.
Of the 415 eligible individuals, a total of 324 (78.1%) patients participated in the study. The mean age of the participants was 72 years, 52.2% were female, and the median CHA2DS2-VASc score of the participants was 3. In the target population, 34 (8.2%) individuals had previously diagnosed AF. Among participants without previously known AF, 16 (5.5%) cases of AF were detected. The final AF prevalence in the target population was 12%. Oral anticoagulant therapy was successfully initiated in 88% of these patients with newly detected AF.
The AF screening project exhibited a high participation rate and resulted in a high rate of newly discovered AF; of these newly diagnosed patients, 88% could be treated with an oral anticoagulant.
心房颤动（AF）是缺血性中风的主要危险因素，除非用抗凝剂治疗。由于 AF 常为阵发性且无症状，因此很难发现。本研究旨在开发一种筛查模型，以在初级保健环境中检测 AF，并在高危患者中启动口服抗凝治疗以预防中风。
这是一项横断面研究。在斯德哥尔摩的一个单一初级保健中心注册的所有 70-74 岁的个体在十个月的时间内访问该中心时被邀请参加 AF 筛查。在此期间未与该中心联系的人通过信件邀请他们参加。在没有 AF 的参与者中，使用手持 Zenicor 设备在两周内每天两次进行 32 秒间歇性 ECG 记录。为新发现的 AF 患者提供口服抗凝治疗。
在 415 名合格的个体中，共有 324 名（78.1%）患者参加了研究。参与者的平均年龄为 72 岁，52.2%为女性，参与者的 CHA2DS2-VASc 评分中位数为 3。在目标人群中，有 34 名（8.2%）个体先前被诊断为 AF。在没有先前已知 AF 的参与者中，有 16 名（5.5%）例 AF 被检出。目标人群中的最终 AF 患病率为 12%。在这些新诊断的 AF 患者中，88%成功启动了口服抗凝治疗。
AF 筛查项目的参与率很高，发现了很高比例的新 AF；在这些新诊断的患者中，88%可以用口服抗凝剂治疗。
