Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population

BACKGROUND the objective of this study is to investigate the detection rate of undiagnosed atrial fibrillation (AF) with short intermittent ECG recordings during four weeks among out-of-hospital patients, having at least one additional risk factor (CHADS2) for stroke. METHOD DESIGN Cross-sectional study. SETTING Eight family practice centres and two hospital-based out-patient clinics in Sweden. SUBJECTS 989 out-of-hospital patients, without known AF, having one or more risk factors associated with stroke (CHADS2). INTERVENTIONS All individuals were asked to perform 10-second handheld ECG recordings during 28 days, twice daily and when having palpitations. MAIN OUTCOME MEASURES Episodes of AF on handheld ECG recordings were defined as irregular supraventricular extrasystoles in series with a duration of 10 seconds. RESULTS 928 patients completed registration. AF was found in 35 of 928 patients; 3.8% (95% confidence interval [CI] 2.7-5.2). These 35 patients had a mean age of 70.7 years (SD ± 7.7; range 53-85) and a median CHADS2 of 2 (range 1-4). CONCLUSIONS Intermittent handheld ECG recording over a four week period had a detection rate of 3.8% newly diagnosed AF, in a population of 928 out-of-hospital patients having at least one additional risk factor for stroke. Intermittent handheld ECG registration is a feasible method to detect AF in patients with an increased risk of stroke in whom oral anticoagulation (OAC) treatment is indicated.