eHealth tool for AF screening may help prevent strokes

By Nicole MacKee
An eHealth-based screening program for atrial fibrillation (AF) in rural general practice may help to prevent up to 150 strokes a year, according to Australian researchers who say the strategy is also cost effective.

In a study published in the Journal of the American Heart Association, researchers recruited eight rural general practices and, between 2018 and 2019, screened more than 3000 patients (mean age 75 years) using a smart-phone ECG.

The practices screened a median of 34% of eligible patients. If implemented nationally, this screening rate could prevent 147 strokes per year, the researchers estimated. And, they said, increasing the proportion of eligible patients screened to 75% would prevent an additional 177 strokes per year.

However, the researchers noted that half of the practices screened only 40 to 50% of eligible patients. They suggested that this may represent a ‘ceiling’ on the proportion of patients able to be screened in a general practice setting.

The researchers reported that the incremental cost-effectiveness ratio for population-based screening was $16,578 per quality adjusted life year gained and $84,383 per stroke prevented compared with no screening.

Associate Professor Ruth Webster, study coauthor and Global Head of Medicine in George Health Technologies (a social enterprise of The George Institute for Global Health), Sydney, said the findings reflected her research group’s earlier results in urban settings.

She said AF was underdiagnosed in the community and many strokes could be prevented with increased detection.

‘We now have better treatments with the nonvitamin K-dependent anticoagulants, but we still have to find those people who can benefit from this therapy,’ she said.

Associate Professor Webster said a key barrier to screening was the time pressures in primary care.

‘General practice is busy,’ she said. ‘We know that’s one reason why screening probably doesn’t happen.’

The researchers used eHealth tools – including electronic prompts, guideline-based electronic decision support and regular data reports – to increase the uptake of screening.

Also, GPs and/or practice nurses used the AliveCor smartphone handheld single-lead ECGs to streamline the screening process.

‘We tried to address some of those existing barriers and to facilitate task-shifting to the practice nurses,’ Associate Professor Webster said.

‘This is quite straightforward. While you are typing up your notes or a script, you can say to the patient, “Here, pop your fingers on this for a moment”. It’s quick, it’s easy, it’s cost effective, and you will be preventing strokes.’
J Am Heart Assoc 2020; 9: e017080; doi: 10.1161/JAHA.120.017080.