iECG: AFib Screening During Vaccination by Primary Care Nurses


https://journals.sagepub.com/doi/full/10.1177/2047487316670255

The AliveCor Heart Monitor is feasible and well-accepted by primary practice staff for the screening of atrial fibrillation during influenza vaccinations.

The rising aging population will be associated with a doubling in the prevalence of atrial fibrillation (AF) in the next 20 years. AF increases the risk of stroke, with at least 1 in 3 strokes being AF-related. AF-related strokes are highly preventable with the use of oral coagulants (OACs), so regular screening in non-symptomatic patients can help in timely AF diagnosis and management with OACs.

This cross-sectional pilot study evaluated the feasibility of AF screening using a handheld ECG device (AliveCor heart monitor) among people aged ≥65 years during their flu vaccination appointments in general practices.

Five general practices in Sydney, Australia were recruited by convenience sampling. Practice nurses received 45-minute training sessions on the use of the AliveCor Heart Monitor and the screening protocol. Eligible participants (those over aged ≥65 attending flu vaccination appointments) held a smartphone to record their ECG for 30 seconds. The nurse then entered the patient’s details into the AliveCor app, and the ECG was imported wirelessly into the patient’s electronic medical record. The AliveCor Heart Monitor algorithm determined whether the ECG was normal, was indicative normal, or could not be classified. A 12-lead ECG was obtained if AF was detected or the smartphone-recorded ECG could not be classified.

The study reported that:

  • Out of the 972 participants who had their ECGs recorded, 44 ECG readings were identified as possible AF by the AliveCor Heart Monitor algorithm.
  • Out of the 44 participants with possible AF, 15 did not have an AF history. 12-lead ECG readings confirmed AF in 8 of these patients. Hence, newly identified AF was found in 0.8% of participants who had their ECG recorded in the AliveCor Heart Monitor.
  • The AliveCor Heart Monitor algorithm detected AF with a sensitivity of 95% (95% CI: 83–99%) and a specificity of 99% (95% CI: 98–100%).
  • The AliveCor Heart Monitor was well-received by the GPs, patients, and nurses. GPs and patients really liked the device, and the nurses were confident during the screening process.

Conclusion: The smartphone-enabled AliveCor Heart Monitor is feasible and well-accepted by primary practice staff and patients for AF screening in older patients. This indicates future scope in implementing cost-effective AF screening during regular health checkups and vaccination appointments at primary care practices.