Screening for Atrial Fibrillation in Older Adults at Primary Care Visits - VITAL-AF

Mar 09, 2022
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Bristol Myers Squibb-Pfizer Alliance.
Date Published:
03/02/2022
Original Posted Date:
03/09/2022
References

Contribution To Literature:

The VITAL-AF trial failed to show that atrial fibrillation screening resulted in a higher prevalence of newly diagnosed atrial fibrillation.

Description:

The goal of the trial was to evaluate atrial fibrillation screening compared with usual care among patients presenting to primary care practice.

Study Design

  • Cluster randomization
  • Parallel

Patients presenting to the primary care clinic were randomized to atrial fibrillation screening (n = 15,393) versus usual care (n = 15,322). Atrial fibrillation screening was performed with the AliveCor KardiaMobile electrocardiogram (ECG) device during vital sign assessment.

  • Total number of enrollees: 30,715
  • Duration of follow-up: 12 months
  • Mean patient age: 73.9 years
  • Percentage female: 60%
  • Percentage with diabetes: 24%

Inclusion criteria:

  • Patients ≥65 years of age presenting to primary care clinic

Other salient features/characteristics:

  • CHA2DS2-VASc score: 3.4

Principal Findings:

The primary outcome, newly diagnosed atrial fibrillation at 1 year, occurred in 1.72% of the atrial fibrillation screening group compared with 1.59% of the usual care group (p = 0.38).

Secondary outcomes: Among those ≥85 years of age, newly diagnosed atrial fibrillation at 1 year occurred in 5.56% of the atrial fibrillation screening group compared with 3.76% of the usual care group (p < 0.05).

Interpretation:

Among patients presenting to a primary care clinic, atrial fibrillation screening is feasible but did not result in a higher prevalence of newly diagnosed atrial fibrillation. There was suggestion of effectiveness among those ≥85 years of age; however, this warrants further evaluation.

References:

Lubitz SA, Atlas SJ, Ashburner JM, et al. Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: The VITAL-AF Randomized Controlled Trial. Circulation 2022;Mar 2:[Epub ahead of print].

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Geriatric Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Electrocardiography, Geriatrics, Mass Screening, Primary Health Care, Vital Signs


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