Smartphone-based A-fib Screen Works in American Indian Population

NEW YORK (Reuters Health) – Use of a smartphone-based single-lead ECG is a good way to identify silent atrial fibrillation (AF) in the adult American Indian population, according to a new study.

American Indians have higher risk of atrial fibrillation compared with all other racial and ethnic groups. Yet, “systematic screening among American Indians has never been done before, and the true rate of atrial fibrillation in this population is unknown,” lead investigator Dr. Stavros Stavrakis, of the University of Oklahoma, in Oklahoma City, said in a statement.

The researchers studied 2,323 adults (mean age, 61 years; 62% women) from a tribal healthcare system in Oklahoma who did not have a history of AF; 1,019 were given a 30-second, single-lead ECG using a mobile device paired with a tablet or smartphone at the clinic, while 1,267 clinic patients in a control group received standard care based on clinical symptoms alone.

AF was diagnosed in 15 patients (1.5%) screened for AF compared with only four (0.3%) of those in the control group (mean difference, 1.2%; P=0.002). Therefore, screening for AF led to a greater than four-fold increase in the rate of new AF diagnosis.

Notably, say the researchers, over half (8/15) of those with new screen-identified AF were younger than age 65, the age recommended for AF screening according to European Society of Cardiology recommendations. None of the patients with screen-detected AF had any symptoms of AF. All but one patient started on anticoagulation therapy.

“In this study, we demonstrated that single-time point, single-lead ECG screening for AF is feasible and well accepted by American Indians aged >50 years in a primary, rural tribal clinic setting. Importantly, AF screening detects significantly more AF than usual care in this population at risk for stroke, with subsequent initiation of anticoagulation,” the authors write in the Journal of the American Heart Association.

They note that the Kardia mobile ECG device used in the study had a sensitivity of 93.3% and specificity 99.7%, and positive and negative predictive values of 82.4% and 99.9%, respectively, consistent with previously reported values.

“Our study shows that we have a very simple and accurate method to screen and diagnose atrial fibrillation that is easy to implement at tribal clinics,” Dr. Stavrakis said in the statement.

“This widely-available, low-cost approach has real potential to improve health outcomes among American Indians,” he added.

The next step will be to do a randomized, controlled trial to get more robust data, Dr. Stavrakis said.

The study was funded by a grant from the National Institutes of Health/National Institute on Minority Health and Health Disparities. The authors have declared no conflicts of interest.

SOURCE: Journal of the American Heart Association, online April 21, 2021.

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