Point-of-Care Atrial Fibrillation Screening With a Handheld Single-Lead ECG

In a study published in Circulation, researchers explored whether point-of-care screening with a handheld single-lead ECG during primary care visits would increase the diagnosis of atrial fibrillation (AF). Primary investigator Steven A. Lubitz and colleagues ultimately proposed that “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.”

The trial encompassed 16 primary care clinics, which were randomized to either AF screening with a handheld ECG during vital signs measurements or to usual care. During the visit, screening findings were provided to primary care providers, who then made all follow-up decisions. The primary endpoint was the frequency of new AF diagnoses during a one-year follow-up period.

Among 30,715 patients without prevalent AF, 15,393 were screened and 15,322 were provided usual care. Reportedly, the incidence of new AF diagnoses in the screening group was 1.72% compared with 1.59% in the control group (risk difference = 0.13%; 95% confidence interval [CI], –0.16 to 0.42; p = 0.38). In prespecified analyses, the authors found a greater incidence of AF diagnoses in patients aged 85 years or older in both groups.

Though the authors had designed the study with the hope of improving AF screening recommendations and ultimately preventing strokes associated with undiagnosed AF, the use of a handheld single-lead ECG at primary care provider centers was not effective at increasing diagnoses of AF.