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Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients

OBJECTIVE: To determine the diagnostic yield of repeated screening for atrial fibrillation (AF) among geriatric patients. METHODS: A pragmatic prospective cohort study into applying opportunistic screening for AF with a handheld single lead ECG device (SLD) in a geriatric cohort. Consecutive patient...

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Autores principales: Zwart, Lennaert AR, Jansen, René WMM, Ruiter, Jacob H, Germans, Tjeerd, Simsek, Suat, Hemels, Martin EW
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Science Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118016/
https://www.ncbi.nlm.nih.gov/pubmed/32280331
http://dx.doi.org/10.11909/j.issn.1671-5411.2020.03.007
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author Zwart, Lennaert AR
Jansen, René WMM
Ruiter, Jacob H
Germans, Tjeerd
Simsek, Suat
Hemels, Martin EW
author_facet Zwart, Lennaert AR
Jansen, René WMM
Ruiter, Jacob H
Germans, Tjeerd
Simsek, Suat
Hemels, Martin EW
author_sort Zwart, Lennaert AR
collection PubMed
description OBJECTIVE: To determine the diagnostic yield of repeated screening for atrial fibrillation (AF) among geriatric patients. METHODS: A pragmatic prospective cohort study into applying opportunistic screening for AF with a handheld single lead ECG device (SLD) in a geriatric cohort. Consecutive patients of 65 years old and older visiting the geriatric outpatient clinic were eligible for inclusion. A 12 lead ECG was performed, followed by measurements with the SLD during every visit to the geriatric outpatient clinic. A frailty index was based on the accumulation of deficits model. RESULTS: 478 patients were eligible. Patients were excluded if they did not give informed consent (17 patients), had a pacemaker or implantable cardioverter defibrillator (20 patients), or had incomplete medical files (two patients). After exclusion, 439 patients participated in this study. The mean age was 78 years (range 65 to 100 years), 54% were female. AF was known in 89 patients (20%), first detected on the baseline ECG in four patients (1%) and first detected with the SLD in 20 patients (5%) during follow up visits. Sensitivity of the SLD was 90.0%, specificity 99.0%, negative predictive value 99.7%, and positive predictive value 73.5%. Most patients (82%) with AF were frail and 53% were severely frail. CONCLUSION: Repeated screening in geriatric patients has a five times higher diagnostic yield than usual care. It was easily combined with usual care. Because of the positive predictive value of 73.5%, it remains necessary to confirm AF with a 12 lead ECG or 24-h Holter monitoring.
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spelling pubmed-71180162020-04-10 Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients Zwart, Lennaert AR Jansen, René WMM Ruiter, Jacob H Germans, Tjeerd Simsek, Suat Hemels, Martin EW J Geriatr Cardiol Research Article OBJECTIVE: To determine the diagnostic yield of repeated screening for atrial fibrillation (AF) among geriatric patients. METHODS: A pragmatic prospective cohort study into applying opportunistic screening for AF with a handheld single lead ECG device (SLD) in a geriatric cohort. Consecutive patients of 65 years old and older visiting the geriatric outpatient clinic were eligible for inclusion. A 12 lead ECG was performed, followed by measurements with the SLD during every visit to the geriatric outpatient clinic. A frailty index was based on the accumulation of deficits model. RESULTS: 478 patients were eligible. Patients were excluded if they did not give informed consent (17 patients), had a pacemaker or implantable cardioverter defibrillator (20 patients), or had incomplete medical files (two patients). After exclusion, 439 patients participated in this study. The mean age was 78 years (range 65 to 100 years), 54% were female. AF was known in 89 patients (20%), first detected on the baseline ECG in four patients (1%) and first detected with the SLD in 20 patients (5%) during follow up visits. Sensitivity of the SLD was 90.0%, specificity 99.0%, negative predictive value 99.7%, and positive predictive value 73.5%. Most patients (82%) with AF were frail and 53% were severely frail. CONCLUSION: Repeated screening in geriatric patients has a five times higher diagnostic yield than usual care. It was easily combined with usual care. Because of the positive predictive value of 73.5%, it remains necessary to confirm AF with a 12 lead ECG or 24-h Holter monitoring. Science Press 2020-03 /pmc/articles/PMC7118016/ /pubmed/32280331 http://dx.doi.org/10.11909/j.issn.1671-5411.2020.03.007 Text en Institute of Geriatric Cardiology http://creativecommons.org/licenses/by-nc-sa/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission.
spellingShingle Research Article
Zwart, Lennaert AR
Jansen, René WMM
Ruiter, Jacob H
Germans, Tjeerd
Simsek, Suat
Hemels, Martin EW
Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients
title Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients
title_full Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients
title_fullStr Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients
title_full_unstemmed Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients
title_short Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients
title_sort opportunistic screening for atrial fibrillation with a single lead device in geriatric patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118016/
https://www.ncbi.nlm.nih.gov/pubmed/32280331
http://dx.doi.org/10.11909/j.issn.1671-5411.2020.03.007
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