12/29/2023 0 Comments Icd 10 atrial flutterThe primary outcomes of the trial have been previously published. To address this uncertainty, the VITAL-AF trial assessed the feasibility and efficacy of population-based screening for AF in older patients using a 30-s handheld single-lead ECG during routine primary care visits. Preventive Services Task Force (USPSTF) found the current evidence is insufficient to assess the balance of benefits and harms of screening for AF, it states that pulse palpation is considered to be usual care. Current American Heart Association/American College of Cardiology guidelines do not directly address screening. The European Society of Cardiology recommend opportunistic screening for AF by pulse palpation or ECG in patients ≥ 65 years of age and consideration of systematic ECG screening in individuals age ≥ 75 years or those at high risk of stroke. Guidelines differ with regard to screening for AF. An advantage of screening at a primary care visit is that the PCP can immediately initiate evaluation and treatment if AF is identified. Screening using consumer wearable technologies can identify patients with AF, but patients may not follow up with a physician following an abnormal result. Screening studies have been performed in various clinical and non-clinical settings. Methods to screen for AF include pulse palpation, standard ECGs, wearable ECG patch monitors, and newer techniques such as wrist-worn wearable technologies and handheld ECGs. To forestall such events, there is interest in screening for AF so OAC treatment can be initiated for AF-related stroke prevention. However, AF may be asymptomatic, and patients may first be diagnosed with AF at the time of an acute stroke presentation. AF is often diagnosed when a patient presents with symptoms that lead to obtaining a confirmatory electrocardiogram (ECG). The risk of developing AF increases with age, and having AF confers a fivefold increased risk of stroke, which is largely preventable by long-term use of oral anticoagulants (OACs). Registered May 3, 2018.Ītrial fibrillation (AF) is the most common cardiac arrhythmia and is frequently identified and treated by primary care practitioners (PCPs). PCPs were largely uncertain about AF screening done outside of practice visits. PCPs exposed to a SL-ECG device preferred it over pulse palpation. Though the benefits and harms of screening for AF remain uncertain, most older patients underwent screening and PCPs were able to manage SL-ECG results, supporting the feasibility of routine primary care screening. Both groups were less certain if AF screening should be done outside of office visits with patch monitors (47% unsure) or consumer devices (54% unsure). 83.6%, respectively), though SL-ECG screening was favored by intervention PCPs (86%) while control PCPs favored pulse palpation (65%). Among the 208 PCPs completing a survey (73.6% 78.9% intervention, 67.7% control), most favored screening for AF (87.2% vs. Same-day 12-lead ECGs were slightly more frequent among intervention (7.0%) than control (6.2%) encounters ( p = 0.07). The positive predictive value of a “Possible AF” result (4.7% of SL-ECG tracings) at an encounter prior to a new AF diagnosis was 9.5%. Screening occurred at 78% of 38,502 individual encounters, and 91% of patients completed ≥ 1 screening. Resultsįifteen thousand three hundred ninety three patients were seen in intervention practices (mean age 73.9 years old, 59.7% female). Outcomes included screening uptake and results, and PCP preferences for screening. Following the trial, PCPs were surveyed about AF screening. Control practices continued with usual care. PCPs were notified of “possible AF” results management was left to their discretion. Screening using a SL-ECG was performed by medical assistants during check-in at 8 intervention sites among verbally consenting patients. All patients ≥ 65 years old without prevalent AF seen during a 1-year period and their PCPs. Secondary analyses of a cluster randomized trial. This study assessed patient and primary care practitioner (PCP) acceptability of screening for AF using a 30-s single-lead electrocardiogram (SL-ECG) during outpatient visits. Screening for atrial fibrillation (AF) is appealing because AF is common, when undiagnosed may increase stroke risk, and stroke is preventable with anticoagulants.
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