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Atrial Fibrillation Self-Screening in Practices: A Trial in Early Detection

Each year in Australia, February is recognised as Heart Research Month. On average, one Australian dies as a result of heart disease every 26 minutes, and recent research shows that heart attacks – often associated with older men – are increasingly occurring in younger people.

Prof Ben Freedman, the Deputy Director of Research Strategy at the Heart Research Institute in Sydney, in conjunction with several colleagues, has developed a method for patients to self-screen for risk of atrial fibrillation in General Practice. 

The following contains excerpts from the complete published study. A link is available at the bottom of this article.

Atrial fibrillation is the most common arrhythmia in older adults, and is associated with thromboembolic disease in major vascular beds. Stroke is also identified as the most debilitating condition associated with atrial fibrillation, with around one-third of ischemic strokes being caused by atrial fibrillation. These are often more disabling or fatal, and the arrhythmia may also lead to other morbidities such as heart failure, cognitive impairment and systemic embolism. Approximately one-third of patients with the condition are asymptomatic, and asymptomatic atrial fibrillation offers a similar stroke risk as symptomatic disease. Unfortunately, a fatal or debilitating stroke may be the first presentation of the condition.

Prof Ben Freedman, leader of the Heart Rhythm and Stroke Group at the Heart Research Institute in Sydney, said that opportunistic screening for silent atrial fibrillation is recommended in guidelines to reduce stroke, but screening rates are sub-optimal in the context of general Practice. His group hypothesizes that patients being able to self-screen while waiting for their appointment may improve screening rates and ultimately, the detection of atrial fibrillation. When atrial fibrillation is found and treated, this should reduce the number of strokes related to atrial fibrillation.

How Does Self-Screening Work?

The study, lead by Dr Katrina Giskes, tests a purpose-designed atrial fibrillation self-screening station which records a lead-1 ECG. This station then seamlessly integrates with Bp Premier in order to deliver the results of the screening to the patient’s electronic medical record.

  • The software automatically scans the Practice appointment diary for eligible patients – 65 years or older, with no current atrial fibrillation diagnosis
  • If a patient makes an appointment for a consultation, it will send eligible patients an automated SMS reminder, just prior to their scheduled appointment
  • The software creates a QR code which is printed out at Practice reception, and is handed to patients upon their arrival. They then scan the QR code at the self-screening station
  • The screening station has an ECG device (Kardia Mobile), where patients place their fingers. The device transmits and ECG rhythm strip to the iPad attached to the station
  • Once the self-screening has been completed, the ECG and diagnosis is imported directly into the patients’ electronic medical record in Bp Premier
Atrial Fibrillation Self-Screening Station | Best Practice Software

Between 5 and 8 general Practices in New South Wales will participate in the trial, with the aim of having 1,500 patients undertake self-screening.

The outcomes measured will be the proportion of eligible patients that undertook a self-screening, the incidence of newly-diagnosed atrial fibrillation, and patient and staff experience of the self-screening process. From there, de-identified data will be collected using a clinical auditing tool, and further interviews will be conducted to determine patient and staff acceptability of the process.

An automated self-screening station where patients can undertake a screening prior to the GP appointment is a potentially feasible solution to improving detection of undiagnosed atrial fibrillation in patients. Dr Nicole Lowres suggests that if the trial is initially well received, an upscaling of this system may enable the widespread implementation of the atrial fibrillation screening guidelines, and may achieve higher screening rates, thereby potentially reducing the personal and economic burdens of preventable stokes.

To read the complete study, please click on the link below.
Atrial Fibrillation self screening, management and guideline recommended therapy: A protocol for atrial fibrillation self-screening in general practice

Best Practice Software would like to thank Katrina Giskes, Nicole Lowres, Jialin Li, Jessica Orchard, Charlotte Hespe and Ben Freedman for access and use of this study in the publishing of this article.