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Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF...

Libby Ellins Orcid Logo, Kathie Wareham, Daniel Harris, Matthew Hanney, Ashley Akbari Orcid Logo, Mark Gilmore, James P Barry, Ceri Phillips, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

European Heart Journal Open, Volume: 3, Issue: 3

Swansea University Authors: Libby Ellins Orcid Logo, Daniel Harris, Ashley Akbari Orcid Logo, Ceri Phillips, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

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Abstract

Aims: Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of sy...

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Published in: European Heart Journal Open
ISSN: 2752-4191
Published: Oxford University Press (OUP) 2023
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa63344
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Abstract: Aims: Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of systematic electrocardiogram (ECG) screening on cardiovascular outcomes is unclear. Methods and results: In the original REHEARSE-AF study, patients were randomized to twice-weekly portable electrocardiogram (iECG) assessment or routine care. After discontinuing the trial portable iECG assessment, electronic health record data sources provided longer-term follow-up analysis. Cox regression was used to provide unadjusted and adjusted hazard ratios (HR) [95% confidence intervals (CI)] for clinical diagnosis, events, and anticoagulant prescriptions during the follow-up period. Over the median 4.2-year follow-up, although a greater number of patients were diagnosed with AF in the original iECG group (43 vs. 31), this was not significant (HR 1.37, 95% CI 0.86–2.19). No differences were seen in the number of strokes/systemic embolisms or deaths between the two groups (HR 0.92, 95% CI 0.54–1.54; HR 1.07, 95% CI 0.66–1.73). Findings were similar when restricted to those with CHADS-VASc ≥ 4. Conclusion: A 1-year period of home-based, twice-weekly screening for AF increased diagnoses of AF for the screening period but did not lead to increased diagnoses of AF or a reduction in cardiovascular-related events or all-cause death over a median of 4.2 years, even in those at highest risk of AF. These results suggest that benefits of regular ECG screening over a 1-year period are not maintained after cessation of the screening protocol.
Keywords: Atrial fibrillation, Electrocardiography, Mass screening, Preventive medicine, Stroke
College: Faculty of Medicine, Health and Life Sciences
Funders: Swansea University
Issue: 3