Introduction: Atrial fibrillation (AF) is the commonest cardiac arrhythmia in clinical practice that is associated with increased risk of stroke, heart failure and cardio-vascular mortality. It is often undiagnosed and undertreated as patients tend to be asymptomatic. Systemic screening at community level for atrial fibrillation with smartphone electrogram had shown to pick up undiagnosed AF, but the data in Asia Pacific region is scarce. Hence, the aim of this study is to assess the feasibility of smartphone electrogram for atrial fibrillation screening in Malaysian elderly.
Methods: In the period between 1st January 2018 to 31st December 2018, 2,149 participants were screened with smartphone electrogram using Kardia Mobile (AliveCorVR, Mountain View, CA, USA) in the community-based AF screening programme. The inclusion criteria included age ≥65 years old who consented to the study. The electrograms were classified into three groups, namely sinus rhythm, AF and uninterpretable. Participants with uninterpretable electrogram were referred conventional 12-lead ECGs, which were reviewed by the prime investigator.
Results: 137 (6.4%) out of 2,149 smartphone electrogram were uninterpretable. 44 (2%) participants had newly diagnosed AF, with 31 (70.4%) were asymptomatic. The prevalence rates of AF detected by smartphone electrogram was 6.9% and prevalence rates of AF detected by smartphone electrogram or self reported by participants was 8.1%. Using multivariable logistic regression analysis, independent predictors of AF include male gender, history of stroke, heart failure, valvular heart disease and thyroid disease.
Conclusion: Community screening for AF with smartphone electrogram was feasible and effective. The prevalence rates of AF in Malaysian elderly was comparable to western population. High proportion of newly diagnosed asymptomatic AF (70.4%) illustratrated the importance of community screening in elderly population.