Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
Heart. 2020 Aug;106(16):1261-1266. doi: 10.1136/heartjnl-2019-316277. Epub 2020 Feb 4.
A novel handheld dual-electrode stick is a portable atrial fibrillation (AF) screening device (AFSD). We evaluated AFSD performance in primary care patients referred for echocardiogram (echo).
The AFSD has a light indication of irregular rhythm and single-lead ECG recording. Patients were instructed to hold the device for 1 min, and AF indication was recorded. A 12-lead ECG was performed for all AFSD-positive patients and 250 patients with negative AFSD screen. Echos were performed based on a clinical risk score: all high-risk patients and a sampling of low-risk patients underwent complete echo. Intermediate risk patients first had a screening echocardiogram, with a follow-up complete study if abnormality was suspected.
In 5 days, 1518 patients underwent clinical evaluation and cardiovascular risk stratification: mean age 58±16 years, 66% women. The AFSD was positive in 6.4%: 12.6% high risk, 6.1% intermediate risk and 2.2% low risk. Older age was a risk factor (9.3% vs 4.8% in those more than and less than 65 years, p=0.001). AFSD positive was independently associated with heart disease in echo (OR=3.9, 95% CI 2.1 to 7.2, p<0.001). Compared with 12-lead ECG, the AFSD had sensitivity of 90.2% (95% CI 77.0% to 97.3%) and specificity of 84.0% (95% CI 79.3% to 88.0%) for AF detection.
AFSD demonstrated high sensitivity for AF detection in primary care patients referred for echo. AF prevalence was substantial and independently associated with structural or functional heart disease, suggesting that AFSD screening could be a useful primary care tool to stratify risk and prioritise echo.
一种新型手持式双电极棒是一种便携式心房颤动（AF）筛查设备（AFSD）。我们评估了 AFSD 在因超声心动图（echo）检查而转诊的初级保健患者中的表现。
AFSD 有不规则节律的光指示和单导联心电图记录。患者被指示握住设备 1 分钟，并记录 AF 指示。对所有 AFSD 阳性患者和 250 名 AFSD 阴性患者进行 12 导联心电图检查。Echo 根据临床风险评分进行：所有高危患者和部分低危患者进行完整的 echo。中危患者首先进行筛查超声心动图，如果怀疑有异常，则进行后续的完整研究。
在 5 天内，对 1518 名患者进行了临床评估和心血管风险分层：平均年龄 58±16 岁，66%为女性。AFSD 阳性率为 6.4%：高危患者占 12.6%，中危患者占 6.1%，低危患者占 2.2%。年龄较大是一个危险因素（65 岁以上患者为 9.3%，65 岁以下患者为 4.8%，p=0.001）。AFSD 阳性与 echo 中心脏疾病独立相关（OR=3.9，95%CI 2.1 至 7.2，p<0.001）。与 12 导联心电图相比，AFSD 对 AF 的检测灵敏度为 90.2%（95%CI 77.0%至 97.3%），特异性为 84.0%（95%CI 79.3%至 88.0%）。
AFSD 在因 echo 检查而转诊的初级保健患者中对 AF 检测具有很高的敏感性。AF 的患病率相当高，且与结构性或功能性心脏病独立相关，这表明 AFSD 筛查可能是一种有用的初级保健工具，可用于分层风险和优先安排 echo 检查。
