BACKGROUND: Atrial fibrillation (AF) is the most common clinically significant cardiac rhythm disorder. There is considerable interest in screening for AF, as it is a leading cause of stroke, and oral anticoagulants (OACs) have been shown to significantly reduce the risk of stroke in patients with AF. Improved screening for AF with subsequent treatment may help improve long-term outcomes, but the optimal patient population and screening intensity are unknown. OBJECTIVES: In this study, we prospectively evaluated the use of the CHA2DS2-VASc score for the prediction of new-onset AF using insertable cardiac monitors (ICMs) and examined whether this screening led to the initiation of OAC therapy. METHODS: We enrolled 245 subjects with no history of AF and CHA2DS2-VASc score ≥2 to be screened for AF with an ICM. The ICMs were programmed to record AF episodes ≥6 minutes in duration. Subjects were followed for 18 months with monthly remote interrogations and all events adjudicated by cardiologists. In subjects diagnosed with AF, medical records were reviewed to determine subsequent care. RESULTS: During a mean follow-up of 451 ± 185 days, the incidence of AF was 22.4% (95% confidence interval 17.2%-27.7%) with a mean time to detection of 141.3 ± 139.5 days. Among subjects newly diagnosed with AF, 76.4% were prescribed anticoagulation with either a novel OAC (n = 38) or warfarin (n = 4). CONCLUSION: In this large prospective cohort of subjects with CHA2DS2-VASc scores ≥2, 22.4% were newly diagnosed with AF and the majority of these subjects were given OACs, suggesting a potential role of ICMs in AF screening. Published by Elsevier Inc.
BACKGROUND:Atrial fibrillation (AF) is the most common clinically significant cardiac rhythm disorder. There is considerable interest in screening for AF, as it is a leading cause of stroke, and oral anticoagulants (OACs) have been shown to significantly reduce the risk of stroke in patients with AF. Improved screening for AF with subsequent treatment may help improve long-term outcomes, but the optimal patient population and screening intensity are unknown. OBJECTIVES: In this study, we prospectively evaluated the use of the CHA2DS2-VASc score for the prediction of new-onset AF using insertable cardiac monitors (ICMs) and examined whether this screening led to the initiation of OAC therapy. METHODS: We enrolled 245 subjects with no history of AF and CHA2DS2-VASc score ≥2 to be screened for AF with an ICM. The ICMs were programmed to record AF episodes ≥6 minutes in duration. Subjects were followed for 18 months with monthly remote interrogations and all events adjudicated by cardiologists. In subjects diagnosed with AF, medical records were reviewed to determine subsequent care. RESULTS: During a mean follow-up of 451 ± 185 days, the incidence of AF was 22.4% (95% confidence interval 17.2%-27.7%) with a mean time to detection of 141.3 ± 139.5 days. Among subjects newly diagnosed with AF, 76.4% were prescribed anticoagulation with either a novel OAC (n = 38) or warfarin (n = 4). CONCLUSION: In this large prospective cohort of subjects with CHA2DS2-VASc scores ≥2, 22.4% were newly diagnosed with AF and the majority of these subjects were given OACs, suggesting a potential role of ICMs in AF screening. Published by Elsevier Inc.
Authors: James A Reiffel; Atul Verma; Peter R Kowey; Jonathan L Halperin; Bernard J Gersh; Rolf Wachter; Erika Pouliot; Paul D Ziegler Journal: JAMA Cardiol Date: 2017-10-01 Impact factor: 14.676
Authors: William F McIntyre; Pablo A Mendoza; Emilie P Belley-Côté; Richard P Whitlock; Kevin J Um; Natalie Maystrenko; P J Devereaux; David Conen; Jorge A Wong; Stuart J Connolly; Jeff S Healey Journal: Clin Cardiol Date: 2018-10-18 Impact factor: 2.882
Authors: Geoffrey H Tison; José M Sanchez; Brandon Ballinger; Avesh Singh; Jeffrey E Olgin; Mark J Pletcher; Eric Vittinghoff; Emily S Lee; Shannon M Fan; Rachel A Gladstone; Carlos Mikell; Nimit Sohoni; Johnson Hsieh; Gregory M Marcus Journal: JAMA Cardiol Date: 2018-05-01 Impact factor: 14.676
Authors: Ben Freedman; Giuseppe Boriani; Taya V Glotzer; Jeff S Healey; Paulus Kirchhof; Tatjana S Potpara Journal: Nat Rev Cardiol Date: 2017-07-06 Impact factor: 32.419
Authors: Claudia I Rinciog; Laura M Sawyer; Alexander Diamantopoulos; Mitchell S V Elkind; Matthew Reynolds; Stylianos I Tsintzos; Paul D Ziegler; Maria E Quiroz; Claudia Wolff; Klaus K Witte Journal: Open Heart Date: 2019-06-20
Authors: Vincenzo Russo; Anna Rago; Vincenzo Tavoletta; Valter Bianchi; Cristina Carella; Giuseppe Ammirati; Aniello Viggiano; Stefano De Vivo; Antonio Rapacciuolo; Gerardo Nigro; Antonio D'Onofrio Journal: J Atr Fibrillation Date: 2018-08-31