Modi Rakesh N, Massou Efthalia, Charlton Peter H, Dymond Andrew, Williams Kate, Brimicombe James, Freedman Ben, Griffin Simon J, Hobbs F D Richard, Lip Gregory Y H, McManus Richard J, Mant Jonathan
Department of Public Health and Primary Care, Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, 2 Worts' Causeway, Cambridge, CB1 8RN, UK.
Heart Research Institute, University of Sydney, Room 3114, Level 3 East, D17 - Charles Perkins Centre, Sydney, NSW, 2006, Australia.
BMC Prim Care. 2025 May 26;26(1):185. doi: 10.1186/s12875-025-02878-y.
There has been a drive to increase atrial fibrillation (AF) detection in general practice. However, one-off, opportunistic testing can miss paroxysmal AF and requires significant resource. Paroxysmal AF can be detected through screening that involves repeated ECGs over a period of time, although it is unclear whether screening would need to be led by general practice, and how much support participants require. We aimed to investigate whether AF screening can be delivered remotely by a centralised administration instead of general practice, and to determine the level of support required.
We undertook a controlled comparator study with secondary randomisation in three English general practices. We invited people aged ≥ 70 years to use a hand-held ECG device four times daily for three weeks. Participants were allocated to practice-led or administrator-led screening, with administrator-led support randomised to three different levels. We compared quantity and quality of ECGs obtained in each arm. The primary outcome was proportion of screened participants who recorded ≥ 56 adequate-quality ECGs (2/3 of possible ECGs).
Of 288 screened participants, 59 participants received practice-led screening with a telephone consultation to explain the device. The remainder received administrator-led screening: 81 were automatically given a consultation; 74 were offered a consultation, and 74 were not offered a consultation. Most screened participants (280/288, 97.2%) recorded ≥ 56 adequate-quality ECGs. This proportion did not vary significantly between practice-led and administrator-led screening (100.0% vs. 98.8%), or between support levels (94.6% to 98.8%). Practice-led screening led to slightly more adequate-quality ECGs (mean: 83.9 vs 78.3, p < 0.001).
AF screening can be successfully delivered remotely, outside general practice, with minimal support.
在全科医疗中，人们一直在努力提高房颤（AF）的检测率。然而，一次性的机会性检测可能会漏诊阵发性房颤，并且需要大量资源。阵发性房颤可以通过一段时间内重复进行心电图检查的筛查来检测，尽管尚不清楚筛查是否需要由全科医疗主导，以及参与者需要多少支持。我们旨在研究房颤筛查是否可以由中央管理机构而非全科医疗远程进行，并确定所需的支持水平。
我们在英国的三个全科医疗诊所进行了一项带有二次随机化的对照比较研究。我们邀请年龄≥70岁的人每天使用手持心电图设备四次，持续三周。参与者被分配到由诊所主导或由管理员主导的筛查组，由管理员主导的支持被随机分为三个不同级别。我们比较了每组获得的心电图数量和质量。主要结局是记录了≥56份质量合格心电图（占可能心电图数量的2/3）的筛查参与者的比例。
在288名接受筛查的参与者中，59名参与者接受了由诊所主导的筛查，并通过电话咨询来解释该设备。其余参与者接受了由管理员主导的筛查：81名自动获得了咨询；74名被提供了咨询，74名未被提供咨询。大多数接受筛查的参与者（共288名中的280名，97.2%）记录了≥56份质量合格的心电图。这一比例在由诊所主导和由管理员主导的筛查之间（100.0%对98.8%）或支持级别之间（94.6%至98.8%）没有显著差异。由诊所主导的筛查产生的质量合格心电图略多一些（平均值：83.9对78.3，p<0.001）。
房颤筛查可以在全科医疗之外成功地通过远程方式进行，且只需极少的支持。
