A randomized controlled implementation study integrating patient self-screening with a remote central monitoring system to screen community dwellers aged 75 years and older for atrial fibrillation

Kam Cheong Wong; Tu N Nguyen; Simone Marschner; Samual Turnbull; Anupama Balasuriya Indrawansa; Rose White; Mason Jenner Burns; Vishal Gopal; Haeri Min; Desi Quintans; Amy von Huben; Steven A Trankle; Tim Usherwood; Richard I Lindley; Saurabh Kumar; Clara K Chow

doi:10.1093/eurjpc/zwae312

A randomized controlled implementation study integrating patient self-screening with a remote central monitoring system to screen community dwellers aged 75 years and older for atrial fibrillation

Eur J Prev Cardiol. 2024 Dec 23;31(18):2104-2114. doi: 10.1093/eurjpc/zwae312.

Authors

Kam Cheong Wong^{1

2

3

4}, Tu N Nguyen^{1

5}, Simone Marschner¹, Samual Turnbull^{1

6}, Anupama Balasuriya Indrawansa¹, Rose White¹, Mason Jenner Burns¹, Vishal Gopal¹, Haeri Min¹, Desi Quintans¹, Amy von Huben^{7

8}, Steven A Trankle⁹, Tim Usherwood^{1

10}, Richard I Lindley^{1

10}, Saurabh Kumar^{1

6}, Clara K Chow^{1

2

5

6

10}

Affiliations

¹ Westmead Applied Research Centre, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, 176 Hawkesbury Road, Westmead, NSW 2145, Australia.
² Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, 176 Hawkesbury Road, Westmead, NSW 2145, Australia.
³ Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW 2795, Australia.
⁴ School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange, NSW 2800, Australia.
⁵ The George Institute for Global Health, Level 18, International Towers 3, 300 Barangaroo Ave, Sydney, NSW 2000, Australia.
⁶ Department of Cardiology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW 2145, Australia.
⁷ School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
⁸ Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, NSW 2006, Australia.
⁹ School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia.
¹⁰ Charles Perkins Centre, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW 2050, Australia.

PMID: 39319703
DOI: 10.1093/eurjpc/zwae312

Abstract

Aims: Diagnosis of atrial fibrillation (AF) provides opportunities to reduce stroke risk. This study aimed to compare AF diagnosis rates, participant satisfaction, and feasibility of an electrocardiogram (ECG) self-screening virtual care system with usual care.

Methods and results: This randomized controlled implementation study involving community-dwelling people aged ≥75 years was conducted from May 2021 to June 2023. Participants were given a handheld single-lead ECG device and trained to self-record ECGs once daily on weekdays for 12 months. The control group received usual care with their general practitioners in the first 6 months and participated in the subsequent 6 months. Atrial fibrillation diagnosis and participant satisfaction were assessed at 6 months. Two hundred participants (mean age 79.0 ± 3.4 years; 54.0% female; 72.5% urban) were enrolled. Atrial fibrillation was diagnosed in 10/97 (10.3%) intervention participants and 2/100 (2.0%) in the control group (odds ratio 5.6, 95% confidence interval 1.4-37.3, P = 0.03). In the intervention, 80% of AF cases were diagnosed within 3 months. 91/93 (97.9%) intervention participants and 55/93 (59.1%) control-waitlisted participants (P < 0.001) were satisfied with AF screening. Of the expected 20 days per month, the overall monthly median number of days participants self-recorded ECGs was 20 (interquartile range 17-22). Participants were confident using the device (93%), reported it was easy to use (98%), and found screening efficient (96%).

Conclusion: Patient-led AF self-screening using single-lead ECG devices with a remote central monitoring system was feasible, acceptable, and effective in diagnosing AF among older people. This screening model could be adapted for implementation, interfacing with integrated care models within existing health systems.

Registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000184875.

Keywords: Atrial fibrillation; Digital health; Electrocardiogram; Screening; Stroke.

Plain language summary

Our screening model involves virtual enrolment and training participants aged ≥75 years to use handheld single-lead electrocardiogram devices. With a remote central support system, older people are empowered to use handheld devices to self-screen atrial fibrillation (AF) at home or elsewhere in the community. This innovative screening model was feasible and acceptable, with high adherence to self-screening among older participants (mean age of 79 years). It yielded a five-fold higher rate of AF diagnosis at 6 months compared with standard usual care and needed 12 participants screened to find one additional AF. This screening model can be implemented, interfacing with (i.e. communicating, connecting, and supporting) the existing healthcare systems. If implemented at scale, it could provide better access and quality of AF screening and care to remote and high-risk populations.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Aged, 80 and over
Atrial Fibrillation* / diagnosis
Electrocardiography
Electrocardiography, Ambulatory / instrumentation
Feasibility Studies*
Female
Humans
Independent Living
Male
Mass Screening / methods
Patient Satisfaction
Predictive Value of Tests
Remote Sensing Technology / instrumentation
Telemedicine
Time Factors

Grants and funding

102936/Heart Foundation of Australia