ESC Congress 2017 In Review – Focus on Arrhythmias - 9
ESC Congress 2017
Late-Breaking Registry Results
In Review
Arrhythmias
Atrial Fibrillation Screening Using
a Smartphone App: Results of the
AFinder Program
Written by Brian Hoyle
A study of over 10,000 people in Hong Kong has indicated the feasibility of a smartphone application (app) that
screens for atrial fibrillation (AF) in the general community. However, the app's diagnostic performance needs
improvement before routine use is possible.
The AFinder program results were presented by
Ngai-Yin Chan, MD, Princess Margaret Hospital, Hong Kong.
AF is a disease that is suitable for screening, and
conventional medical screening is recommended for
people aged ≥ 65 years. Recent studies have indicated
the potential value of a smartphone app that provides
electrocardiogram data in the broader community
screening of AF [Lowres N et al. Thromb Haemost. 2014;
Svennberg E et al. Circulation. 2015; Chan PH et al. J Am
Health Assoc. 2016; Chan NY et al. Heart. 2017].
The AFinder program investigated the feasibility of
a community-based screening program in over 10,000
citizens of Hong Kong aged ≥ 50 years. The primary
outcomes were the number needed to screen (NNS) to
diagnose one case of AF and the NNS for one appropriately treated, newly diagnosed AF. Secondary outcomes were the prevalence of previously known but
undertreated AF and the diagnostic performance of the
smartphone app.
Trained layperson volunteers assisted in 118 community AF screening sessions held at 108 community centres in Hong Kong from November 2015 to September
2016. Information concerning AF history and symptoms,
subsequent medical treatments, compliance, and medical conditions were sought through base-line questionnaires completed at the time of screening and follow-up
9 months later.
Of the 11,574 Hong Kong residents who were screened,
interpretable data were available for 10,735 (92.8%). Of
these, 244 (2.3%) had AF, with 74 cases (0.69%) being
newly diagnosed. The NNS for one newly diagnosed AF
was 145.
Of the 74 newly diagnosed cases, oral anticoagulation treatment was indicated in 72. Forty-seven of the 74
newly diagnosed people sought medical treatment. Of
these, 17 participants received oral anticoagulation and
30 participants did not (among this latter group, 17 were
prescribed aspirin, 1 was given clopidogrel and 12 nothing). The NNS for one case of newly diagnosed AF who
subsequently received oral anticoagulation was 671.
People with newly diagnosed AF were older, less likely to have had a stroke, and less likely to have peripheral
artery disease (Table 1). Forty-eight percent of the newly
diagnosed cases were asymptomatic.
Table 1. Characteristics of Newly Diagnosed AF
All
Newly
Known
Participants Diagnosed
AF
With AF
AF
(n = 133)
(n = 244)
(n = 74)
P value
Age
79.5±7.9
81.1±7.3
78.1±8.1
.007
Sex (F), n(%)
172 (70.5)
51 (68.9)
97 (72.9)
.542
Heart failure, n(%)
17 (7.0)
6 (8.1)
9 (6.8)
.738
Hypertension, n(%)
172 (70.5)
50 ( 67.6)
95 (71.4)
.569
Diabetes, n(%)
63 (25.8)
19 (25.7)
34 (25.6)
.973
Stroke, n(%)
40 (16.4)
22 (16.5)
.0004
Coronary artery disease, n(%)
25 (10.2)
7 (9.5)
12 (9.0)
.920
Peripheral artery disease, n(%)
8 (3.3)
0
7 (5.3)
.045
Medical conditions
9 (12.2)
Reproduced with permission from NY Chan, MD.
Appropriate treatment with oral anticoagulation therapies of newly diagnosed and known AF patients was
unsatisfactory, according to Dr. Chan, with respective
rates of 22.2% and 33.8%. Among the 133 patients with
known AF, the comparative analysis of those who were
appropriately treated and undertreated revealed significant differences in the prevalence of stroke (31.1%
vs 9.1%; P = .001) and peripheral artery disease (11.1%
vs 2.3%; P = .033). Of the 88 patients with known AF,
not receiving oral anticoagulation, one-quarter was taking an antiplatelet drug (which was aspirin in all but one
patient).
Article continued on page 10.
Official Peer-Reviewed Highlights From ESC Congress 2017
9
Table of Contents for the Digital Edition of ESC Congress 2017 In Review – Focus on Arrhythmias
Contents
ESC Congress 2017 In Review – Focus on Arrhythmias - Cover1
ESC Congress 2017 In Review – Focus on Arrhythmias - Cover2
ESC Congress 2017 In Review – Focus on Arrhythmias - 1
ESC Congress 2017 In Review – Focus on Arrhythmias - 2
ESC Congress 2017 In Review – Focus on Arrhythmias - Contents
ESC Congress 2017 In Review – Focus on Arrhythmias - 4
ESC Congress 2017 In Review – Focus on Arrhythmias - 5
ESC Congress 2017 In Review – Focus on Arrhythmias - 6
ESC Congress 2017 In Review – Focus on Arrhythmias - 7
ESC Congress 2017 In Review – Focus on Arrhythmias - 8
ESC Congress 2017 In Review – Focus on Arrhythmias - 9
ESC Congress 2017 In Review – Focus on Arrhythmias - 9A
ESC Congress 2017 In Review – Focus on Arrhythmias - 9B
ESC Congress 2017 In Review – Focus on Arrhythmias - 10
ESC Congress 2017 In Review – Focus on Arrhythmias - 11
ESC Congress 2017 In Review – Focus on Arrhythmias - 12
ESC Congress 2017 In Review – Focus on Arrhythmias - 13
ESC Congress 2017 In Review – Focus on Arrhythmias - 14
ESC Congress 2017 In Review – Focus on Arrhythmias - 15
ESC Congress 2017 In Review – Focus on Arrhythmias - 16
ESC Congress 2017 In Review – Focus on Arrhythmias - 17
ESC Congress 2017 In Review – Focus on Arrhythmias - 18
ESC Congress 2017 In Review – Focus on Arrhythmias - Cover3
ESC Congress 2017 In Review – Focus on Arrhythmias - Cover4
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