Okabe Shinichi, Sato Akiyoshi, Kasuya Hiromichi, Sugiyama Koichi, Endo Satoshi, Mitsunari Hiroaki, Kamata Kenichi, Yamagata Masaru, Katayanagi Tatsuya
Seirei Memorial Hospital.
Nexsimo Corporation.
Nihon Ronen Igakkai Zasshi. 2018;55(3):402-410. doi: 10.3143/geriatrics.55.402.
Atrial fibrillation (AF), which can lead to cardioembolic stroke, is often not properly diagnosed in hospital outpatient departments or medical clinics. We therefore used a pulse analysis to screen patients for AF, and examined the benefits of using this method in screening.
We performed screening of the hospital's first-visit and ambulatory patients during the afternoon in 2014 (total number, 50,875; true number, 16,356), mainly targeting patients older than 65 years of age. Among the true number of outpatients, the device was used on 5,013 patients, 8,656 times. We independently developed a pulse analysis software application which analyzed the pulse interval variation. We assessed the accuracy of this analytical method in the detection of AF.
AF was detected in 56 patients, who were considered for or introduced to anticoagulation treatment. In their cases, the method was considered useful for detecting undiagnosed or untreated AF. This figure amounts to 0.34% of all outpatients and 1.1% of the patients who were screened in 2014. The average age was 76.9±7.7 years, 67.9% of the patients had a CHADS score of more than 2, half had a history of arrhythmia in the past, and 37.5% were first-visit patients. The sensitivity of the device used was 89.7%.
Using the method described in this study, we detected asymptomatic AF in numerous patients, and demonstrated that this method is potentially useful in screening outpatients for asymptomatic AF.
心房颤动（AF）可导致心源性栓塞性卒中，在医院门诊或诊所中常常未得到正确诊断。因此，我们采用脉搏分析对患者进行AF筛查，并研究了使用该方法进行筛查的益处。
我们于2014年下午对医院的初诊和门诊患者进行了筛查（总数50875例；实际人数16356例），主要针对65岁以上的患者。在实际的门诊患者中，该设备应用于5013例患者，共8656次。我们自主研发了一款分析脉搏间期变化的脉搏分析软件应用程序。我们评估了这种分析方法在检测AF方面的准确性。
共检测出56例AF患者，这些患者被考虑或接受了抗凝治疗。在这些病例中，该方法被认为有助于检测未诊断或未治疗的AF。这一数字占所有门诊患者的0.34%，占2014年接受筛查患者的1.1%。平均年龄为76.9±7.7岁，67.9%的患者CHADS评分超过2分，一半患者既往有心律失常病史，37.5%为初诊患者。所用设备的灵敏度为89.7%。
使用本研究中描述的方法，我们在众多患者中检测到了无症状AF，并证明该方法在筛查门诊患者的无症状AF方面可能有用。
