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Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: VITAL-AF Randomized Controlled Trial

Steven A. Lubitz

Steven A. Lubitz

Correspondence to: Steven A. Lubitz, MD, MPH, Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114. Email

E-mail Address: [email protected]

https://orcid.org/0000-0002-9599-4866

Demoulas Center for Cardiac Arrhythmias and Cardiovascular Research Center (S.A.L., S.K., P.T.E.), Massachusetts General Hospital, Boston.

Harvard Medical School, Boston, MA (S.A.L., J.M.A., S.K., P.T.E., Y.C., D.E.S.).

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Steven J. Atlas

Steven J. Atlas

Division of General Internal Medicine (S.J.A., J.M.A., L.H.B., Y.C., D.E.S.), Massachusetts General Hospital, Boston.

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Jeffrey M. Ashburner

Jeffrey M. Ashburner

https://orcid.org/0000-0002-5600-3492

Division of General Internal Medicine (S.J.A., J.M.A., L.H.B., Y.C., D.E.S.), Massachusetts General Hospital, Boston.

Harvard Medical School, Boston, MA (S.A.L., J.M.A., S.K., P.T.E., Y.C., D.E.S.).

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Ana T. Trisini Lipsanopoulos

Ana T. Trisini Lipsanopoulos

Division of Cardiology (A.T.T.L.), Massachusetts General Hospital, Boston.

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Leila H. Borowsky

Leila H. Borowsky

Division of General Internal Medicine (S.J.A., J.M.A., L.H.B., Y.C., D.E.S.), Massachusetts General Hospital, Boston.

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Wyliena Guan

Wyliena Guan

University of North Carolina, Chapel Hill (W.G.).

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Shaan Khurshid

Shaan Khurshid

https://orcid.org/0000-0002-2840-4539

Demoulas Center for Cardiac Arrhythmias and Cardiovascular Research Center (S.A.L., S.K., P.T.E.), Massachusetts General Hospital, Boston.

Harvard Medical School, Boston, MA (S.A.L., J.M.A., S.K., P.T.E., Y.C., D.E.S.).

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Patrick T. Ellinor

Patrick T. Ellinor

https://orcid.org/0000-0002-2067-0533

Demoulas Center for Cardiac Arrhythmias and Cardiovascular Research Center (S.A.L., S.K., P.T.E.), Massachusetts General Hospital, Boston.

Harvard Medical School, Boston, MA (S.A.L., J.M.A., S.K., P.T.E., Y.C., D.E.S.).

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Yuchiao Chang

Yuchiao Chang

Division of General Internal Medicine (S.J.A., J.M.A., L.H.B., Y.C., D.E.S.), Massachusetts General Hospital, Boston.

Harvard Medical School, Boston, MA (S.A.L., J.M.A., S.K., P.T.E., Y.C., D.E.S.).

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David D. McManus

David D. McManus

Division of General Internal Medicine (S.J.A., J.M.A., L.H.B., Y.C., D.E.S.), Massachusetts General Hospital, Boston.

Department of Medicine, University of Massachusetts Medical School, Worcester (D.D.M.).

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and

Daniel E. Singer

Daniel E. Singer

https://orcid.org/0000-0001-6145-4848

Harvard Medical School, Boston, MA (S.A.L., J.M.A., S.K., P.T.E., Y.C., D.E.S.).

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Originally published2 Mar 2022https://doi.org/10.1161/CIRCULATIONAHA.121.057014Circulation. 2022;145:946–954

This article is commented on by the following:
- Atrial Fibrillation Screening: The Tools Are Ready, But Should We Do It?

Abstract

Background:

Undiagnosed atrial fibrillation (AF) may cause preventable strokes. Guidelines differ regarding AF screening recommendations. We tested whether point-of-care screening with a handheld single-lead ECG at primary care practice visits increases diagnoses of AF.

Methods:

We randomized 16 primary care clinics 1:1 to AF screening using a handheld single-lead ECG (AliveCor KardiaMobile) during vital sign assessments, or usual care. Patients included were ages ≥65 years. Screening results were provided to primary care clinicians at the encounter. All confirmatory diagnostic testing and treatment decisions were made by the primary care clinician. New AF diagnoses during the 1-year follow-up were ascertained electronically and manually adjudicated. Proportions and incidence rates were calculated. Effect heterogeneity was assessed.

Results:

Of 30 715 patients without prevalent AF (n=15 393 screening [91% screened], n=15 322 control), 1.72% of individuals in the screening group had new AF diagnosed at 1 year versus 1.59% in the control group (risk difference, 0.13% [95% CI, –0.16 to 0.42]; P=0.38). In prespecified subgroup analyses, new AF diagnoses in the screening and control groups were greater among those aged ≥85 years (5.56% versus 3.76%, respectively; risk difference, 1.80% [95% CI, 0.18 to 3.30]). The difference in newly diagnosed AF between the screening period and the previous year was marginally greater in the screening versus control group (0.32% versus –0.12%; risk difference, 0.43% [95% CI, –0.01 to 0.84]). The proportion of individuals with newly diagnosed AF who were initiated on oral anticoagulants was not different in the screening (n=194, 73.5%) and control (n=172, 70.8%) arms (risk difference, 2.7% [95% CI, –5.5 to 10.4]).

Conclusions:

Screening for AF using a single-lead ECG at primary care visits did not affect new AF diagnoses among all individuals aged 65 years or older compared with usual care.

Registration:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03515057.

Footnotes

The podcast and transcript are available as Supplemental Material at https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.121.057014.

For Sources of Funding and Disclosures, see page 953.

https://www.ahajournals.org/journal/circ

Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.

Correspondence to: Steven A. Lubitz, MD, MPH, Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, MA 02114. Email [email protected]harvard.edu

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