Opportunistic screening for atrial fibrillation among frail older patients, little effort for a high diagnostic yield. Outcomes of the Dutch-GERAF study.

Abstract

Background and aims: Frailty increases the risk of atrial fibrillation (AF) and its complications. This study investigated the feasibility and diagnostic yield of an eHealth screening for the detection of new AF, in frail older patients.

Methods: Patients referred to the Geriatric Medicine outpatient clinics were eligible. A Frailty Index (FI) was calculated. Patients were screened for AF with electrocardiograms (ECGs) at baseline and a smartphone photoplethysmography (PPG) application, during 6 months.

Results: Nine hundred fifty-two patients (median age 79 years) were included, mean FI of 0.16, 311 were frail (33%) and 751 had sinus rhythm (79%) at baseline. Six hundred forty-one patients (85%) performed PPG recordings (median 2), 295 (39%) at least 3 recordings. Twenty (2.7%) new cases of AF were found, 10 at baseline and 10 during follow-up. Among 16 (2%) patients, additional irregular PPG recordings were acquired, but no confirmatory ECG took place.

Conclusion: The screening strategy proved feasible in very old and frail patients. A diagnostic yield of 2.7% was found by ECG, and an additional 0.9% of new AF cases were suspected on PPG recordings. The non-binding approach of the strategy might be disadvantageous for the patient category. Future PPG AF screening programmes for very old and frail patients should strictly organise their means of AF confirmation.