Population-Based Screening or Targeted Screening Based on Initial Clinical Risk Assessment for Atrial Fibrillation: A Report from the Huawei Heart Study



Guo, Yutao, Wang, Hao, Zhang, Hui, Chen, Yundai and Lip, Gregory YH ORCID: 0000-0002-7566-1626
(2020) Population-Based Screening or Targeted Screening Based on Initial Clinical Risk Assessment for Atrial Fibrillation: A Report from the Huawei Heart Study. JOURNAL OF CLINICAL MEDICINE, 9 (5). E1493-.

Access the full-text of this item by clicking on the Open Access link.

Abstract

<h4>Background</h4>A general-population approach has been advocated to improve the screening of patients with atrial fibrillation (AF). A more pragmatic alternative may be targeted screening of patients at high risk of developing AF. We assess the value of a simple clinical risk score, C<sub>2</sub>HEST (C2, coronary artery disease/chronic obstructive pulmonary disease; COPD (1 point each); H, hypertension; E, elderly (age ≥75, doubled); S, systolic heart failure; HF (doubled); T, hyperthyroidism)); to facilitate population screening and detection of incident AF in the general population, in a prespecified ancillary analysis of the Huawei Heart Study.<h4>Methods</h4>The Huawei Heart Study investigated general population screening for AF, identified using photoplethysmography (PPG)-based HUAWEI smart devices. We compared the value of a general population approach to a target screening approach between 26 October 2018 and 20 November 2019.<h4>Results</h4>There were 644,124 individuals (mean age ± standard deviation, SD 34 ± 11; female 15.9%) who monitored their pulse rhythm using smart devices, among which 209,274 individuals (mean age 34 years, SD11; 10.6% female) completed the questionnaire on cardiovascular risk factors, with 739 detecting AF. Of these, 31.4% (<i>n</i> = 65,810) subjects reported palpitations. The median (interquartile range, IQR) duration to first detected AF was 11 (1-46), 6 (1-49), and 4 (1-24) in the population with low, intermediate, and high C<sub>2</sub>HEST score category, respectively (<i>p</i> = 0.03). Detected AF events rates increased with increasing C<sub>2</sub>HEST score points, stratified by age (<i>p</i> for trend, <i>p</i> < 0.001). Hazard ratios of the components of the C<sub>2</sub>HEST score for detected AF were between 1.31 and 2.75. A combination of symptomatic palpitations and C<sub>2</sub>HEST score increased prediction of AF detection, compared to using C<sub>2</sub>HEST score alone (c-indexes 0.72 vs. 0.76, Delong test, <i>p</i> < 0.001).<h4>Conclusions</h4>The C<sub>2</sub>HEST score, especially when combined with symptoms, could facilitate a targeted population-based screening and preventive strategy for AF.

Item Type: Article
Uncontrolled Keywords: atrial fibrillation, screening, photoplethysmography, clinical risk score
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 06 Jul 2021 09:45
Last Modified: 10 Feb 2024 03:11
DOI: 10.3390/jcm9051493
Open Access URL: https://doi.org/10.3390/jcm9051493
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3128987