REHEARSE-AF: iECG Screening to Detect AFib in Older, High-Risk Patients
Earlier identification of atrial fibrillation (AFib) using regular, twice-weekly iECG screening with appropriate anticoagulation may decrease stroke morbidity and mortality in high-risk patients over the age of 65, said researchers presenting data from the REHEARSE-AF trial at ESC Congress 2017 in Barcelona. An almost four-fold increase in the diagnosis of AFib over the course of a year was also observed.
The study, also published in Circulation, randomized 1,001 patients without AFib to either twice-weekly screening using an AliveCor Kardia monitor attached to a WiFi-enabled iPod (iECG) or routine care. The median patient age was 72.6 years, 534 patients were women and the mean CHADS-VASc score was 3.0. All CHADS-VASc risk factors were evenly distributed between groups. The primary outcome measure was “time to diagnosis of AFib.” Costs per AFib diagnosis and patient satisfaction were also recorded.
Over the course of 12 months, 19 patients in the iECG group were diagnosed with AFib compared with five in the routine care group at a cost per AFib diagnosis of $10,780. Additionally, there were six stroke/transient ischemic attack/systemic embolic events in the iECG group, compared with 10 in the routine care group. Researchers noted the majority of iECG patients expressed satisfaction with the device, finding it easy to use without restricting activities or causing anxiety.
“Our findings suggest that this approach could be considered for AFib screening in routine practice, particularly in the highest-risk patients,” researchers said. “These results support consideration of evaluation in an appropriately powered, event-driven randomized trial to confirm clinical and cost-effectiveness of such an approach to stroke prevention in AFib.”
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