The New Era in AF Screening at Home

We know that hypertension often comes with atrial fibrillation and can present no symptoms but lead to a stroke if left unchecked. Discover Omron Complete – a device that helps your patients easily and accurately screen for their risk at home.

 

What is ECG?

An electrocardiogram (also called ECG) is a test that measures the heart’s electrical activity. With each heartbeat, an electrical signal travels through the heart. This signal causes the heart to contract and pump blood. An ECG records this electrical activity to see how long it takes for the signal to travel and how much activity passes through the heart. It takes the form of waves on a graph that represents cardiac cycles.

Doctors can use this information to detect heart rhythm irregularities.1

 

Complete electrocardiogram:

Atrial fibrillation identification & associated risks

People with high blood pressure have a higher risk—40% in women and 50% in men—of atrial fibrillation (AFib), both of which are leading identifiers of stroke.1 AFib is associated with a 5x greater risk of stroke, but effective treatment may reduce this risk.2-4 In the early stages of AFib, the condition recurs less frequently and is more difficult to detect.

For many people, AFib is currently undetected and therefore untreated. Up to 50% of AFib cases present with no subjective symptoms, making it unlikely to detect in an annual physical exam.5 Along with daily blood pressure measurements, screening with a single-lead electrocardiogram (ECG) is recommended in medical guidelines to help increase AFib detection rates, which may reduce the risk of stroke through earlier treatment.6

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation

Atrial fibrillation is considered as a global burden for patients, physicians and healthcare systems. According to the guidelines, the diagnosis of atrial fibrillation requires documentation of the heart rhythm with an ECG showing atrial fibrillation. An episode lasting at least 30 seconds is considered diagnostic for clinical atrial fibrillation by convention. Several systems can be used for screening such as pulse palpation, automated blood pressure monitors, single-lead ECG devices, PPG devices, other sensors used in applications for smartphones, wrist bands, and watches.

When atrial fibrillation is detected with a screening tool a single-lead ECG tracing of at least 30 seconds or a 12-lead ECG showing atrial fibrillation analyzed by a physician with expertise in ECG rhythm interpretation, is needed to establish a definite diagnosis. Devices which are capable of ECG recordings can also enable direct analysis of the tracings provided by the device.

The guidelines recommend opportunistic atrial fibrillation screening by pulse taking or ECG in patients aged and older than 65 years. A more systematic screening should be considered for individuals aged 75 years and older, or those at high risk of stroke.

Opportunistic screening is also recommended in hypertensive patients since this is the most common aetiological factor associated with the development of atrial fibrillation, and patients with hypertension have a 1.7-fold higher risk of developing atrial fibrillation. Hypertension also adds to the complications of atrial fibrillation, in particular stroke and. Atrial fibrillation patients who have uncontrolled systolic blood pressure levels should be considered high-risk and strict blood pressure control in recommended to reduce the risk of stroke. Hypertension is regarded as a precipitating factor for atrial fibrillation which should be considered as a manifestation of hypertension target-organ damage. Therefore, treatment of hypertension is mandatory in atrial fibrillation patients and should be consistent with the current blood pressure guidelines aiming to achieve ≤130/80 mmHg blood pressure values to reduce adverse outcomes. Lifestyle changes, obesity management, alcohol reduction, and attention to Obstructive Sleep Apnea can also benefit patients with atrial fibrillation and hypertension.

Publications

Several improvements have been made in the management of atrial fibrillation. However, patients with this condition still have an increased risk for cardiovascular complications. An early rhythm control therapy was proven to be associated with a lower risk of cardiovascular outcomes. Read more [Kirchhof P. et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med. 2020 Oct 1;383(14):1305-1316.]

Hypertension is a well known risk factor for stroke in patients with atrial fibrillation. A new device, Complete, combines blood pressure monitoring with ECG monitoring which can accurately differentiate sinus rhythm from atrial fibrillation during a blood pressure measurement. Read more [Senoo K., et al. Diagnostic Value of Atrial Fibrillation by Built-in Electrocardiogram Technology in a Blood Pressure Monitor. 2020. J-STAGE, 2(7): 345-350]

 

References:

1 Verdecchia P, Angeli F, Reboldi G. Hypertension and atrial fibrillation: doubts and certainties from basic and clinical studies. Circ Res. 2018;122(2):352-368

2 Complications: atrial fibrillation. NHS. Reviewed April 24, 2018. Accessed November 2, 2020. https://www.nhs.uk/conditions/atrial-fibrillation/complications

3 Gómez-Outes A, Lagunar-Ruíz J, Terleira-Fernández A, Calvo-Rojas G, Suárez-Gea ML, Vargas-Castrillón E. Causes of death in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol. 2016;68(23):2508-2521

4 Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857-867

5 Esato M, Chun Y, An Y, et al. Clinical impact of asymptomatic presentation status in patients with paroxysmal and sustained atrial fibrillation: the Fushimi AF Registry. Chest. 2017;152(6):1266-1275

6 Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;ehaa612. doi:10.10/93/eurheartj/ehaa612