Suwanwela Nijasri C, Chutinet Aurauma, Autjimanon Hathairat, Ounahachok Tanawat, Decha-Umphai Chumpol, Chockchai Songkhram, Indrabhakti Saowanin, Kijpaisalratana Naruchorn, Akarathanawat Wasan, Travanichakul Suporn, Kitjavijitre Teeraparp, Vongvasinkul Pakkawan, Kanacharoen Ittaporn, Bunlikitkul Tanyaluk O, Charnwut Supparat, Lowres Nicole, Freedman Ben
Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Int J Cardiol Heart Vasc. 2021 Jan 12;32:100709. doi: 10.1016/j.ijcha.2020.100709. eCollection 2021 Feb.
In Thailand, almost one-quarter of strokes are related to atrial fibrillation (AF), and many could be prevented if AF were diagnosed and treated prior to the stroke. Therefore, we tested a novel strategy to screen large numbers of community residents using village health volunteers and primary care nurses.
Local primary care nurses and village health volunteers in Phetchaburi and Lopburi provinces, Thailand were trained to perform AF screening using a blood pressure device with AF algorithm (Microlife A200 AFib). 10% of residents aged ≥ 65 years were randomly selected for screening during home-visits. Participants with possible AF were given follow-up appointments for further testing, including 12-lead ECG and echocardiogram.
Over two-months, 9.7% (13,864/143,478) of the target population were screened: mean age 73.2 ± 6.4 years, 32.4% male. The estimated AF prevalence (detected by Microlife A200 AFib) was 2.8% (95% CI, 2.6-3.1%) for age ≥ 65 years (i.e. 393/13,864 participants). Prevalence increased with age from 1.9% (65-69 years) to 5.0% (≥85 years) (p < 0.001). Only 58% (226/393) of participants with suspected AF attended the follow-up appointment (1-3 months after initial screen): mean CHA2DS2-VASc score 3.2 ± 1.2; 86.3% (195/226) had Class-1 oral anticoagulation recommendation, and 33% (75/226) had AF on 12-lead ECG.
In Thailand, large-scale AF screening in the community is feasible using trained volunteer health workers, allowing screening of large numbers in a short time-period. Further investigation of this strategy is warranted, ensuring mechanisms to obtain a timely rhythm strip or 12-lead ECG locally, and a designated pathway to treatment.
在泰国，近四分之一的中风与心房颤动（AF）有关，如果在中风之前诊断并治疗AF，许多中风是可以预防的。因此，我们测试了一种利用乡村健康志愿者和初级保健护士对大量社区居民进行筛查的新策略。
泰国碧武里府和华富里府的当地初级保健护士和乡村健康志愿者接受了使用带有AF算法的血压设备（Microlife A200 AFib）进行AF筛查的培训。在上门家访期间，随机选择10%年龄≥65岁的居民进行筛查。对可能患有AF的参与者进行后续预约以便进一步检查，包括12导联心电图和超声心动图检查。
在两个月的时间里，对目标人群的9.7%（13,864/143,478）进行了筛查：平均年龄73.2±6.4岁，男性占32.4%。年龄≥65岁人群中AF的估计患病率（通过Microlife A200 AFib检测）为2.8%（95%可信区间，2.6 - 3.1%）（即13,864名参与者中的393人）。患病率随年龄增长从1.9%（65 - 69岁）升至5.0%（≥8岁）（p<0.001）。在疑似患有AF的参与者中，只有58%（226/393）参加了后续预约（初次筛查后1 - 3个月）：平均CHA2DS2 - VASc评分为3.2±1.2；86.3%（195/226）有1级口服抗凝治疗推荐，33%（75/226）在12导联心电图上显示有AF。
在泰国，利用经过培训的志愿卫生工作者在社区进行大规模AF筛查是可行的，能够在短时间内对大量人群进行筛查。有必要对该策略进行进一步研究，确保在当地及时获取心律条或12导联心电图的机制，以及指定的治疗途径。
