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Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF...

Libby Ellins Orcid Logo, Kathie Wareham, Daniel Harris, Matthew Hanney, Ashley Akbari Orcid Logo, Mark Gilmore, James P Barry, Ceri Phillips, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

European Heart Journal Open, Volume: 3, Issue: 3

Swansea University Authors: Libby Ellins Orcid Logo, Daniel Harris, Ashley Akbari Orcid Logo, Ceri Phillips, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

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DOI (Published version): 10.1093/ehjopen/oead047

Abstract

Aims: Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of sy...

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Published in: European Heart Journal Open
ISSN: 2752-4191
Published: Oxford University Press (OUP) 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa63344
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Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of systematic electrocardiogram (ECG) screening on cardiovascular outcomes is unclear. Methods and results: In the original REHEARSE-AF study, patients were randomized to twice-weekly portable electrocardiogram (iECG) assessment or routine care. After discontinuing the trial portable iECG assessment, electronic health record data sources provided longer-term follow-up analysis. Cox regression was used to provide unadjusted and adjusted hazard ratios (HR) [95% confidence intervals (CI)] for clinical diagnosis, events, and anticoagulant prescriptions during the follow-up period. Over the median 4.2-year follow-up, although a greater number of patients were diagnosed with AF in the original iECG group (43 vs. 31), this was not significant (HR 1.37, 95% CI 0.86&#x2013;2.19). No differences were seen in the number of strokes/systemic embolisms or deaths between the two groups (HR 0.92, 95% CI 0.54&#x2013;1.54; HR 1.07, 95% CI 0.66&#x2013;1.73). Findings were similar when restricted to those with CHADS-VASc &#x2265; 4. Conclusion: A 1-year period of home-based, twice-weekly screening for AF increased diagnoses of AF for the screening period but did not lead to increased diagnoses of AF or a reduction in cardiovascular-related events or all-cause death over a median of 4.2 years, even in those at highest risk of AF. 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spelling 2023-07-24T12:07:01.2977519 v2 63344 2023-05-04 Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study 553ce2abe05a6396e7dd6eadb6b90a6d 0000-0001-5164-6416 Libby Ellins Libby Ellins true false e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 932c7a406ab4b6e4a881d422ca03c289 Ceri Phillips Ceri Phillips true false 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2023-05-04 MEDS Aims: Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of systematic electrocardiogram (ECG) screening on cardiovascular outcomes is unclear. Methods and results: In the original REHEARSE-AF study, patients were randomized to twice-weekly portable electrocardiogram (iECG) assessment or routine care. After discontinuing the trial portable iECG assessment, electronic health record data sources provided longer-term follow-up analysis. Cox regression was used to provide unadjusted and adjusted hazard ratios (HR) [95% confidence intervals (CI)] for clinical diagnosis, events, and anticoagulant prescriptions during the follow-up period. Over the median 4.2-year follow-up, although a greater number of patients were diagnosed with AF in the original iECG group (43 vs. 31), this was not significant (HR 1.37, 95% CI 0.86–2.19). No differences were seen in the number of strokes/systemic embolisms or deaths between the two groups (HR 0.92, 95% CI 0.54–1.54; HR 1.07, 95% CI 0.66–1.73). Findings were similar when restricted to those with CHADS-VASc ≥ 4. Conclusion: A 1-year period of home-based, twice-weekly screening for AF increased diagnoses of AF for the screening period but did not lead to increased diagnoses of AF or a reduction in cardiovascular-related events or all-cause death over a median of 4.2 years, even in those at highest risk of AF. These results suggest that benefits of regular ECG screening over a 1-year period are not maintained after cessation of the screening protocol. Journal Article European Heart Journal Open 3 3 Oxford University Press (OUP) 2752-4191 Atrial fibrillation, Electrocardiography, Mass screening, Preventive medicine, Stroke 2 5 2023 2023-05-02 10.1093/ehjopen/oead047 http://dx.doi.org/10.1093/ehjopen/oead047 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) Swansea University 2023-07-24T12:07:01.2977519 2023-05-04T09:46:54.6808423 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Libby Ellins 0000-0001-5164-6416 1 Kathie Wareham 2 Daniel Harris 3 Matthew Hanney 4 Ashley Akbari 0000-0003-0814-0801 5 Mark Gilmore 6 James P Barry 7 Ceri Phillips 8 Michael Gravenor 0000-0003-0710-0947 9 Julian Halcox 0000-0001-6926-2947 10 63344__27607__5f757f6a719544b282231aaef63be74b.pdf 63344.pdf 2023-05-24T16:37:02.4343813 Output 426607 application/pdf Version of Record true This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com true eng https://creativecommons.org/licenses/by-nc/4.0/
title Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study
spellingShingle Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study
Libby Ellins
Daniel Harris
Ashley Akbari
Ceri Phillips
Michael Gravenor
Julian Halcox
title_short Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study
title_full Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study
title_fullStr Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study
title_full_unstemmed Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study
title_sort Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study
author_id_str_mv 553ce2abe05a6396e7dd6eadb6b90a6d
e60c9c73b645f0e8033ae26fa8e634b8
aa1b025ec0243f708bb5eb0a93d6fb52
932c7a406ab4b6e4a881d422ca03c289
70a544476ce62ba78502ce463c2500d6
3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv 553ce2abe05a6396e7dd6eadb6b90a6d_***_Libby Ellins
e60c9c73b645f0e8033ae26fa8e634b8_***_Daniel Harris
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
932c7a406ab4b6e4a881d422ca03c289_***_Ceri Phillips
70a544476ce62ba78502ce463c2500d6_***_Michael Gravenor
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
author Libby Ellins
Daniel Harris
Ashley Akbari
Ceri Phillips
Michael Gravenor
Julian Halcox
author2 Libby Ellins
Kathie Wareham
Daniel Harris
Matthew Hanney
Ashley Akbari
Mark Gilmore
James P Barry
Ceri Phillips
Michael Gravenor
Julian Halcox
format Journal article
container_title European Heart Journal Open
container_volume 3
container_issue 3
publishDate 2023
institution Swansea University
issn 2752-4191
doi_str_mv 10.1093/ehjopen/oead047
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
url http://dx.doi.org/10.1093/ehjopen/oead047
document_store_str 1
active_str 0
description Aims: Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of systematic electrocardiogram (ECG) screening on cardiovascular outcomes is unclear. Methods and results: In the original REHEARSE-AF study, patients were randomized to twice-weekly portable electrocardiogram (iECG) assessment or routine care. After discontinuing the trial portable iECG assessment, electronic health record data sources provided longer-term follow-up analysis. Cox regression was used to provide unadjusted and adjusted hazard ratios (HR) [95% confidence intervals (CI)] for clinical diagnosis, events, and anticoagulant prescriptions during the follow-up period. Over the median 4.2-year follow-up, although a greater number of patients were diagnosed with AF in the original iECG group (43 vs. 31), this was not significant (HR 1.37, 95% CI 0.86–2.19). No differences were seen in the number of strokes/systemic embolisms or deaths between the two groups (HR 0.92, 95% CI 0.54–1.54; HR 1.07, 95% CI 0.66–1.73). Findings were similar when restricted to those with CHADS-VASc ≥ 4. Conclusion: A 1-year period of home-based, twice-weekly screening for AF increased diagnoses of AF for the screening period but did not lead to increased diagnoses of AF or a reduction in cardiovascular-related events or all-cause death over a median of 4.2 years, even in those at highest risk of AF. These results suggest that benefits of regular ECG screening over a 1-year period are not maintained after cessation of the screening protocol.
published_date 2023-05-02T08:05:17Z
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