Response to letter to the editor regarding: "Atrial fibrillation prevalence and risk profile from novel community-based screening in Thailand: A prospective multi-centre study".

Dear Dr Siu and colleagues

We thank you for presenting these interesting data which nicely illustrate atrial fibrillation (AF) prevalence increasing by nearly 5-fold in Thailand over the last 20 years [1]. It is important to highlight these recent increases in East Asia, so that national health policy can respond to the rising problem of AF, which may be occurring throughout East Asia. We agree that further studies are required to provide high quality data regarding sustainable screening strategies.

We also agree that it is important to highlight the issue of higher risk factor prevalence in Asians compared to Caucasians, especially hypertension. This high prevalence of hypertension is reflected in our study, as 65% of all participants had hypertension [2]. Thus, the concept of screening for AF in the community setting using a blood pressure device with an AF algorithm is a logical proposition. We recognise the pioneering work by Dr Siu and colleagues in Hong Kong validating the Microlife blood pressure device as a screening device for AF [3], [4]. The accepted limitation of using this device is the high false positive rate, which we discuss in our paper. Therefore, for future screening strategies using a blood pressure device with an AF algorithm, it is imperative that a timely confirmation of diagnosis is made for all suspected AF cases. The mechanism for achieving this may vary between countries, and also within countries from province to province, or district to district, depending on available resources. Ideally a 12-lead ECG would be performed on the same day, however the practicalities of this are difficult. It is more feasible for a same-day single-lead ECG to be performed using a handheld ECG device with a diagnostic algorithm for AF. This is now recommended as a valid method for AF diagnosis in the latest European guidelines for the management of AF [5]. These guidelines also require that a competent ECG reader reviews the ECG rhythm strip to confirm the diagnosis, which can be facilitated by the easy transmission of the ECG recordings from the handheld devices.

Declaration of Competing Interest

BF reports prior fees and advisory board honoraria from Bayer Pharma AG, Boehringer Ingelheim, Daiichi-Sankyo, Omron and Pfizer/BMS, and grants to the institution for investigator-initiated studies from BMS and Pfizer.