Log in to MyACC
Serial 7-Day ECG Screening for AF in High-Risk Older Women
Quick Takes
- Serial ECG monitoring in postmenopausal women at increased risk for AF is associated with improved detection of AF.
- Further trials to examine outcomes such as stroke and bleeding rates among women diagnosed with AF via serial ECG patch monitoring are warranted.
Study Questions:
Can serial electrocardiogram (ECG) patch monitoring increase the detection of atrial fibrillation (AF) among women at increased risk for AF?
Methods:
Postmenopausal female participants (50-79 years of age) from the WHISH (Women’s Health Initiative Strong and Healthy), a trial to assess the impact of hormone therapy and lifestyle, were potentially eligible for this ancillary study (WHISH STAR [Health Initiative Silent Atrial Fibrillation Recording Study]). Women with an increased risk for AF, defined as a 5-year predicted risk of new-onset AF >5%, but without prior evidence or diagnosis of AF at baseline, were included in the present study. Risk for AF was defined using the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology)-AF clinical prediction score (variables included age, race/ethnicity, height, weight, blood pressure, smoking, diabetes, heart failure, myocardial infarction, and use of antihypertensive medications). Screening for AF was completed using 7-day ECG patch monitors worn at baseline, 6 months, and 12 months from study enrollment. AF was defined as at least 30 seconds of AF or atrial flutter on an ECG patch monitor recording.
Results:
From a total of 14,290 active participants enrolled in the WHISH trial, 4,791 women were randomly selected to participate in the present study, 1,257 (51.8%) to be enrolled in the study, 1,067 returned a baseline monitor, 866 returned the 6-month monitor, and 777 returned the 12-month monitor and had readable data. The mean age of all participants who returned a readable baseline monitor was 79 years, and 92% were white, 4.6% were African American, and 1.5% were Hispanic. With baseline monitoring, 2.5% of the women had AF detected. At 6 months and 12 months, 3.7% and 4.9% of the cohort were diagnosed with AF, respectively. A higher CHARGE-AF score was associated with higher rates of AF detection. A CHARGE-AF score, which predicted AF ≥10%, was associated with 4.2% of women with AF detected at baseline, 5.9% at 6 months, and 7.2% at 12 months. Most participants with patch-identified AF never had a clinical diagnosis of AF (36 of 46 [78%]).
Conclusions:
The investigators concluded that older women with an elevated CHARGE-AF score had a high prevalence of AF on 7-day ECG patch screening. Serial screening over 12 months substantially increased the detection of AF. These data can be useful in helping identify high-risk participants for enrollment in future studies of the management of asymptomatic AF.
Perspective:
These data suggest that serial monitoring of postmenopausal women at increased risk for AF increased the detection of AF in asymptomatic women. However, further research is warranted to examine such monitoring in non-White women and in men. In addition, serial monitoring declined over time, suggesting that information on the potential barriers to monitoring is needed. Last, information on the cost-effectiveness of such monitoring is warranted.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Smoking
Keywords: Antihypertensive Agents, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Blood Pressure, Diabetes Mellitus, Ethnic Groups, Genomics, Geriatrics, Heart Failure, Hormones, Life Style, Myocardial Infarction, Postmenopause, Secondary Prevention, Smoking
< Back to Listings
