Atrial Fibrillation Screening in Elderly Patients With Risk Factors for Stroke. The Value of Prolonged Cardiac Monitoring
Author(s): Mariana Alves, André Rodrigues, Fabrizio Cossutta, Pedro Freitas, João Cruz, Marina Rocha, Manuela Cruz, Teresa Fonseca
Objective: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the elderly and a major cause of stroke. Compared to standard care procedures, prolonged Holter electrocardiogram (ECG) monitoring might increase detection of AF. We aim to determine the prevalence of paroxysmal AF (PAF) in elderly patients with increased stroke risk and without known AF, using prolonged Holter ECG monitoring in a primary healthcare setting.
Methods: Prospective study with a community convenience sample. Inclusion criteria: age ≥ 65 years, no known AF and at least one additional risk factor for stroke according to the CHA2DS2VASc score. Heart rhythm was determined by continuous 4 day Holter monitoring. The primary endpoint was the detection of AF (lasting ≥ 30 seconds and ≥ 10 seconds).
Results: Fifty patients, mean (SD) age was 72,9 (±5.2) years, were included. Thirty-six (72%) were female. Forty patients (80%) had at least two additional risk factors for stroke. Mean duration of monitoring was 93 hours. Atrial fibrillation was detected in 7 out of 50 patients (14%). Two thirds of arrhythmias were detected in the first 24h of monitoring. An additional 4% (2 incidences) of PAF were found by prolonging cardiac monitoring to 96 hours.
Conclusions: The prevalence of undiagnosed PAF in primary health practice is high. Most cases of PAF were detected in the first 24h. Holter ECG monitoring proved effective in detecting a considerable number of events and is well-tolerated, which would allow it to be used as a screening method.