Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;122(2):286-294.
doi: 10.1055/a-1588-8867. Epub 2021 Sep 29.

Atrial Fibrillation Detected by Single Time-Point Handheld Electrocardiogram Screening and the Risk of Ischemic Stroke

Wen Sun  1 , Ben Freedman  2 , Carlos Martinez  3 , Christopher Wallenhorst  3 , Bryan P Yan  1
Affiliations

Atrial Fibrillation Detected by Single Time-Point Handheld Electrocardiogram Screening and the Risk of Ischemic Stroke

Wen Sun et al. Thromb Haemost. 2022 Feb.

Abstract

Objective: We evaluated stroke risk in patients with single time-point screen-detected atrial fibrillation (AF) and the effect of oral anticoagulants (OACs).

Methods: Consecutive patients aged ≥65 years attending medical outpatient clinics were prospectively enrolled for AF screening using handheld single-lead electrocardiogram (ECG; AliveCor) from December 2014 to December 2017 (NCT02409654). Repeated screening was performed in patients with >1 visit during this period. Three cohorts were formed: screen-detected AF, clinically diagnosed AF, and no AF. Ischemic stroke risk was estimated using adjusted subdistribution hazard ratios (aSHRs) from multivariate regression and no AF as reference, and stratified according to OAC use.

Results: Of 11,972 subjects enrolled, 2,238 (18.7%) had clinically diagnosed AF at study enrollment. The yield of screen-detected AF on initial screening was 2.3% (n = 223/9,734). AF was clinically diagnosed during follow-up in 2.3% (n = 216/9,440) and during subsequent screening in 71 initially screen-negative patients. Compared with no AF, patients with screen-detected AF without OAC treatment had the highest stroke risk (aSHR: 2.63; 95% confidence interval: 1.46-4.72), while aSHR for clinically diagnosed AF without OAC use was 2.01 (1.54-2.62). Among screen-detected AF, the risk of stroke was significantly less with OAC (no strokes in 196 person-years) compared with those not given OAC (12 strokes in 429 person-years), p = 0.01.

Conclusion: The prognosis of single time-point ECG screen-detected AF is not benign. The risk of stroke is high enough to warrant OAC use, and reduced by OAC.

PubMed Disclaimer

Conflict of interest statement

C.M. and C.W. are employees of the Institute for Epidemiology, Statistics and Informatics GmbH. The institute has received grants from Bayer, Bristol-Myers Squibb, CSL Behring, and Merz Pharma, outside the submitted work. B.F. reports grants to the institution, personal fees and nonfinancial support from BMS/Pfizer; grants to the institution, personal fees. and nonfinancial support from Bayer; personal fees and nonfinancial support from Daiichi Sankyo; nonfinancial support from Alivecor; personal fees and nonfinancial support from Omron, all outside the submitted work.