对体弱老年患者进行房颤机会性筛查，诊断率高但付出努力少。荷兰-GERAF研究的结果

Opportunistic screening for atrial fibrillation among frail older patients, little effort for a high diagnostic yield. Outcomes of the Dutch-GERAF study.

作者信息

Zwart Lennaert A R, Spruit Jocelyn R, Jansen René W M M, Riezebos Robert K, Pisters Ron, Louter Leonora, De Vries Kerst, Taekema Diana G, Wold Johan F H, De Groot Joris R, Hemels Martin E W

机构信息

Dijklander Hospital - Department of Geriatric Medicine, Hoorn, Noord-Holland, Netherlands.

Amsterdam UMC Locatie De Boelelaan - Amsterdam Public Health Department, Amsterdam, Noord-Holland, Netherlands.

出版信息

Age Ageing. 2025 Mar 28;54(4). doi: 10.1093/ageing/afaf105.

DOI:10.1093/ageing/afaf105

PMID:40253687

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12009541/

Abstract

BACKGROUND AND AIMS

Frailty increases the risk of atrial fibrillation (AF) and its complications. This study investigated the feasibility and diagnostic yield of an eHealth screening for the detection of new AF, in frail older patients.

METHODS

Patients referred to the Geriatric Medicine outpatient clinics were eligible. A Frailty Index (FI) was calculated. Patients were screened for AF with electrocardiograms (ECGs) at baseline and a smartphone photoplethysmography (PPG) application, during 6 months.

RESULTS

Nine hundred fifty-two patients (median age 79 years) were included, mean FI of 0.16, 311 were frail (33%) and 751 had sinus rhythm (79%) at baseline. Six hundred forty-one patients (85%) performed PPG recordings (median 2), 295 (39%) at least 3 recordings. Twenty (2.7%) new cases of AF were found, 10 at baseline and 10 during follow-up. Among 16 (2%) patients, additional irregular PPG recordings were acquired, but no confirmatory ECG took place.

CONCLUSION

The screening strategy proved feasible in very old and frail patients. A diagnostic yield of 2.7% was found by ECG, and an additional 0.9% of new AF cases were suspected on PPG recordings. The non-binding approach of the strategy might be disadvantageous for the patient category. Future PPG AF screening programmes for very old and frail patients should strictly organise their means of AF confirmation.

摘要

背景与目的

衰弱会增加心房颤动（AF）及其并发症的风险。本研究调查了针对衰弱老年患者进行电子健康筛查以检测新发房颤的可行性和诊断率。

方法

转诊至老年医学门诊的患者符合条件。计算衰弱指数（FI）。在基线时通过心电图（ECG）对患者进行房颤筛查，并在6个月期间使用智能手机光电容积脉搏波描记法（PPG）应用程序进行筛查。

结果

纳入952例患者（中位年龄79岁），基线时平均FI为0.16，311例为衰弱患者（33%），751例为窦性心律（79%）。641例患者（85%）进行了PPG记录（中位数为2次），295例（39%）至少进行了3次记录。发现20例（2.7%）新发房颤病例，10例在基线时发现，10例在随访期间发现。在16例（2%）患者中，获得了额外的不规则PPG记录，但未进行确认性ECG检查。