Introduction
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia globally.1 The Global Burden of Disease study estimated that AF affects over 37 million people globally2 3 The lifetime risk of developing AF at age 55 is estimated to be 37%.4 The risk of developing AF is significantly increased with age4 5 and males are almost twice as likely as females to develop AF.6
In Ireland, AF is estimated to affect approximately 11% of the Irish population aged ≥65 years, with an incidence rate of 0.8%.3 AF prevalence and incidence are projected to rise significantly, due to demographic change and increase of AF in advancing age and comorbidities, cardiovascular risk factors and change in lifestyles.1 7 8 this will impose significant burdens on patients, society and health systems.
AF is a major risk factor for stroke alongside hypertension and smoking.9 AF increases stroke risk fivefold.9 10 Stroke is a leading cause of morbidity and mortality globally.11 Stroke is Ireland’s leading cause of acquired adult disability12 and third-leading cause of death.13 With a global ageing population, stroke prevention is a key public health priority.
AF is often asymptomatic, and patients are frequently diagnosed when they present with a stroke.14 15 In Ireland, approximately 30% of patients who have had a stroke are found to have AF16 and 60% of those who had AF knew of their condition prestroke.16 If AF is identified oral anticoagulation (OAC) can be offered which can reduce stroke risk by up to two-thirds.17
Opportunistic AF screening is recommended nationally and internationally. In Ireland, the National Cardiovascular Policy recommended establishment of an AF screening programme.18 The European Society of Cardiology (ESC) guidelines recommend opportunistic AF screening for the population ≥65 years.19 The National Institute for Health and Care Excellence (NICE)20 and the US Preventive Services Taskforce await emerging evidence regarding the risk of stroke in screen-detected asymptomatic AF compared with symptomatic/clinical AF before recommending screening.19
There are multiple ways to screen for AF including intermittent, opportunistic methods and continuous monitoring methods. Some intermittent AF screening modalities include pulse palpation, 12-lead ECG, mobile ECG devices, oscillometric devices and a number of smart devices including smartphones and watches. Intermittent screening methods can be employed as a single time point or can be repeated over a given timeframe. The continuous screening methods include implantable cardiac monitors, ambulatory ECG monitors and patches. Continuous AF screening methods provide high sensitivity and specificity. Sensitivity and specificity employing intermittent devices vary according to modality. Significant expense is associated with continuous monitoring compared with relatively inexpensive costs associated with intermittent monitoring depending on the modality employed.21
Community settings such as primary care have been identified as a good location to conduct AF screening and one-lead ECG devices have been reported as the preferred screening tool by the international collaboration AF-SCREEN.22 Previous studies have found non-12-lead ECG devices to be more accurate than pulse palpation in the detection of AF.23
This study aims to explore the feasibility of AF screening in Ireland with a one-lead ECG device. The study builds on existing evidence from a screening study conducted in the West of Ireland, which used pulse palpation for screening.3