Wen Sun, Ben Freedman, Carlos Martinez, Christopher Wallenhorst, Christy K Y Chan, Bryan P Yan
{"title":"55- 64岁中国人群手持式心电图检测心房颤动与缺血性卒中风险","authors":"Wen Sun, Ben Freedman, Carlos Martinez, Christopher Wallenhorst, Christy K Y Chan, Bryan P Yan","doi":"10.1016/j.jacasi.2025.06.020","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) screening is recommended at age ≥65 years, but the age threshold in Asians is uncertain because of higher ischemic stroke risk <65 years.</p><p><strong>Objectives: </strong>This study evaluated AF screening yield in a Chinese population aged 55 to 64 years, comparing stroke risk of those with and without AF, and the effect of oral anticoagulants (OAC).</p><p><strong>Methods: </strong>Patients aged 55 to 64 years attending Hong Kong outpatient clinics underwent opportunistic handheld electrocardiogram screening. Repeat screening was performed if >1 clinic visits. Crude incidence rate ratios of ischemic stroke were determined and compared between 3 cohorts: screen-detected AF; clinically diagnosed AF; and no AF. Ischemic stroke risk for all AF categories was compared with individuals without AF, using adjusted subdistribution HRs (aSHRs) accounting for death as a competing risk.</p><p><strong>Results: </strong>Of 3,926 subjects screened, 338 (8.6%) had known AF, and 3,588 had no AF history. New AF yield was 0.8% (28/3,588). AF was clinically diagnosed during follow-up in 2.3% (n = 82) and during subsequent screening in 7 subjects. Of 35 subjects with screen-detected AF, 26 (74%) had ≥1 non-age, non-sex risk factor for stroke, mean age 60.8 ± 2.5 years, and mean CHA<sub>2</sub>DS<sub>2</sub>-VASc score 1.9 ± 1.4. At a median follow-up of 5.0 years, 2 patients (6%) with screen-detected AF experienced ischemic stroke, both with ≥1 non-age, non-sex risk factor. AF exposure without OAC treatment was associated with highest risk of ischemic stroke (aSHR: 3.4 [1.3-8.5]). OAC treatment had similar low ischemic stroke risk as no AF.</p><p><strong>Conclusions: </strong>Although diagnostic yield of AF screening in Chinese patients aged 55 to 64 years is low, those with AF are at increased stroke risk and may warrant being on anticoagulation.</p>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Atrial Fibrillation Detected by Handheld ECG and Ischemic Stroke Risk in a 55- to 64-Year-Old Chinese Population.\",\"authors\":\"Wen Sun, Ben Freedman, Carlos Martinez, Christopher Wallenhorst, Christy K Y Chan, Bryan P Yan\",\"doi\":\"10.1016/j.jacasi.2025.06.020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Atrial fibrillation (AF) screening is recommended at age ≥65 years, but the age threshold in Asians is uncertain because of higher ischemic stroke risk <65 years.</p><p><strong>Objectives: </strong>This study evaluated AF screening yield in a Chinese population aged 55 to 64 years, comparing stroke risk of those with and without AF, and the effect of oral anticoagulants (OAC).</p><p><strong>Methods: </strong>Patients aged 55 to 64 years attending Hong Kong outpatient clinics underwent opportunistic handheld electrocardiogram screening. Repeat screening was performed if >1 clinic visits. Crude incidence rate ratios of ischemic stroke were determined and compared between 3 cohorts: screen-detected AF; clinically diagnosed AF; and no AF. Ischemic stroke risk for all AF categories was compared with individuals without AF, using adjusted subdistribution HRs (aSHRs) accounting for death as a competing risk.</p><p><strong>Results: </strong>Of 3,926 subjects screened, 338 (8.6%) had known AF, and 3,588 had no AF history. New AF yield was 0.8% (28/3,588). AF was clinically diagnosed during follow-up in 2.3% (n = 82) and during subsequent screening in 7 subjects. Of 35 subjects with screen-detected AF, 26 (74%) had ≥1 non-age, non-sex risk factor for stroke, mean age 60.8 ± 2.5 years, and mean CHA<sub>2</sub>DS<sub>2</sub>-VASc score 1.9 ± 1.4. At a median follow-up of 5.0 years, 2 patients (6%) with screen-detected AF experienced ischemic stroke, both with ≥1 non-age, non-sex risk factor. AF exposure without OAC treatment was associated with highest risk of ischemic stroke (aSHR: 3.4 [1.3-8.5]). OAC treatment had similar low ischemic stroke risk as no AF.</p><p><strong>Conclusions: </strong>Although diagnostic yield of AF screening in Chinese patients aged 55 to 64 years is low, those with AF are at increased stroke risk and may warrant being on anticoagulation.</p>\",\"PeriodicalId\":73529,\"journal\":{\"name\":\"JACC. Asia\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-08-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. 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Atrial Fibrillation Detected by Handheld ECG and Ischemic Stroke Risk in a 55- to 64-Year-Old Chinese Population.
Background: Atrial fibrillation (AF) screening is recommended at age ≥65 years, but the age threshold in Asians is uncertain because of higher ischemic stroke risk <65 years.
Objectives: This study evaluated AF screening yield in a Chinese population aged 55 to 64 years, comparing stroke risk of those with and without AF, and the effect of oral anticoagulants (OAC).
Methods: Patients aged 55 to 64 years attending Hong Kong outpatient clinics underwent opportunistic handheld electrocardiogram screening. Repeat screening was performed if >1 clinic visits. Crude incidence rate ratios of ischemic stroke were determined and compared between 3 cohorts: screen-detected AF; clinically diagnosed AF; and no AF. Ischemic stroke risk for all AF categories was compared with individuals without AF, using adjusted subdistribution HRs (aSHRs) accounting for death as a competing risk.
Results: Of 3,926 subjects screened, 338 (8.6%) had known AF, and 3,588 had no AF history. New AF yield was 0.8% (28/3,588). AF was clinically diagnosed during follow-up in 2.3% (n = 82) and during subsequent screening in 7 subjects. Of 35 subjects with screen-detected AF, 26 (74%) had ≥1 non-age, non-sex risk factor for stroke, mean age 60.8 ± 2.5 years, and mean CHA2DS2-VASc score 1.9 ± 1.4. At a median follow-up of 5.0 years, 2 patients (6%) with screen-detected AF experienced ischemic stroke, both with ≥1 non-age, non-sex risk factor. AF exposure without OAC treatment was associated with highest risk of ischemic stroke (aSHR: 3.4 [1.3-8.5]). OAC treatment had similar low ischemic stroke risk as no AF.
Conclusions: Although diagnostic yield of AF screening in Chinese patients aged 55 to 64 years is low, those with AF are at increased stroke risk and may warrant being on anticoagulation.
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