初级保健就诊时对老年人进行房颤筛查：VITAL-AF随机对照试验
Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: VITAL-AF Randomized Controlled Trial.
作者信息
Lubitz Steven A, Atlas Steven J, Ashburner Jeffrey M, Lipsanopoulos Ana T Trisini, Borowsky Leila H, Guan Wyliena, Khurshid Shaan, Ellinor Patrick T, Chang Yuchiao, McManus David D, Singer Daniel E
机构信息
Demoulas Center for Cardiac Arrhythmias and Cardiovascular Research Center (S.A.L., S.K., P.T.E.), Massachusetts General Hospital, Boston.
Harvard Medical School, Boston, MA (S.A.L., J.M.A., S.K., P.T.E., Y.C., D.E.S.).
出版信息
Circulation. 2022 Mar 29;145(13):946-954. doi: 10.1161/CIRCULATIONAHA.121.057014. Epub 2022 Mar 2.
BACKGROUND
Undiagnosed atrial fibrillation (AF) may cause preventable strokes. Guidelines differ regarding AF screening recommendations. We tested whether point-of-care screening with a handheld single-lead ECG at primary care practice visits increases diagnoses of AF.
METHODS
We randomized 16 primary care clinics 1:1 to AF screening using a handheld single-lead ECG (AliveCor KardiaMobile) during vital sign assessments, or usual care. Patients included were ages ≥65 years. Screening results were provided to primary care clinicians at the encounter. All confirmatory diagnostic testing and treatment decisions were made by the primary care clinician. New AF diagnoses during the 1-year follow-up were ascertained electronically and manually adjudicated. Proportions and incidence rates were calculated. Effect heterogeneity was assessed.
RESULTS
Of 30 715 patients without prevalent AF (n=15 393 screening [91% screened], n=15 322 control), 1.72% of individuals in the screening group had new AF diagnosed at 1 year versus 1.59% in the control group (risk difference, 0.13% [95% CI, -0.16 to 0.42]; =0.38). In prespecified subgroup analyses, new AF diagnoses in the screening and control groups were greater among those aged ≥85 years (5.56% versus 3.76%, respectively; risk difference, 1.80% [95% CI, 0.18 to 3.30]). The difference in newly diagnosed AF between the screening period and the previous year was marginally greater in the screening versus control group (0.32% versus -0.12%; risk difference, 0.43% [95% CI, -0.01 to 0.84]). The proportion of individuals with newly diagnosed AF who were initiated on oral anticoagulants was not different in the screening (n=194, 73.5%) and control (n=172, 70.8%) arms (risk difference, 2.7% [95% CI, -5.5 to 10.4]).
CONCLUSIONS
Screening for AF using a single-lead ECG at primary care visits did not affect new AF diagnoses among all individuals aged 65 years or older compared with usual care.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT03515057.
背景
未确诊的心房颤动（房颤）可能导致可预防的中风。关于房颤筛查建议，各指南存在差异。我们测试了在基层医疗就诊时使用手持式单导联心电图进行即时护理筛查是否能增加房颤的诊断率。
方法
我们将16家基层医疗诊所按1:1随机分为两组，一组在生命体征评估期间使用手持式单导联心电图（AliveCor KardiaMobile）进行房颤筛查，另一组接受常规护理。纳入患者年龄≥65岁。筛查结果在就诊时提供给基层医疗临床医生。所有确诊诊断测试和治疗决策均由基层医疗临床医生做出。在1年随访期间新的房颤诊断通过电子方式确定并人工判定。计算比例和发病率。评估效应异质性。
结果
在30715例无房颤病史的患者中（筛查组n = 15393例[91%接受筛查]，对照组n = 15322例），筛查组1.72%的个体在1年时被诊断为新发房颤，而对照组为1.59%（风险差异为0.13%[95%CI，-0.16至0.42]；P = 0.38）。在预先设定的亚组分析中，年龄≥85岁的患者中，筛查组和对照组的新发房颤诊断率更高（分别为5.56%和3.76%；风险差异为1.80%[95%CI，0.18至3.30]）。筛查组与对照组相比，筛查期间与上一年新发房颤的差异略大（0.32%对-0.12%；风险差异为0.43%[95%CI，-0.01至0.84]）。开始使用口服抗凝剂治疗的新发房颤患者比例在筛查组（n = 194，73.5%）和对照组（n = 172，70.8%）中无差异（风险差异为2.7%[95%CI，-5.5至10.4]）。
结论
与常规护理相比，在基层医疗就诊时使用单导联心电图筛查房颤对所有65岁及以上个体的新发房颤诊断并无影响。
注册
网址：https://www.
临床试验
gov；唯一标识符：NCT03515057。
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