Predicting Determinants of Atrial Fibrillation or Flutter for Therapy Elucidation in Patients at Risk for Thromboembolic Events (PREDATE AF) Study

• Published in: Heart rhythm Vol. 14; no. 7; pp. 955 - 961
• Main Authors: Nasir, Javed M., Pomeroy, William, Marler, Adam, Hann, Matthew, Baykaner, Tina, Jones, Ronald, Stoll, Richard, Hursey, Katherine, Meadows, Angela, Walker, Jennifer, Kindsvater, Steve
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial flutter; Device-detected atrial fibrillation; Electrodes, Implanted; Female; Humans; Insertable cardiac monitor; Male; Mass Screening - instrumentation; Mass Screening - methods; Monitoring, Physiologic - instrumentation; Monitoring, Physiologic - methods; Outcome Assessment (Health Care); Prognosis; Propensity Score; Prospective Studies; Risk Assessment - methods; Screening; Thromboembolism - etiology; Thromboembolism - prevention & control; United States - epidemiology; Screening; Insertable cardiac monitor; Device-detected atrial fibrillation; Atrial fibrillation; Atrial flutter
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2017.04.026

Atrial fibrillation (AF) is the most common clinically significant cardiac rhythm disorder. There is considerable interest in screening for AF, as it is a leading cause of stroke, and oral anticoagulants (OACs) have been shown to significantly reduce the risk of stroke in patients with AF. Improved screening for AF with subsequent treatment may help improve long-term outcomes, but the optimal patient population and screening intensity are unknown. In this study, we prospectively evaluated the use of the CHA2DS2-VASc score for the prediction of new-onset AF using insertable cardiac monitors (ICMs) and examined whether this screening led to the initiation of OAC therapy. We enrolled 245 subjects with no history of AF and CHA2DS2-VASc score ≥2 to be screened for AF with an ICM. The ICMs were programmed to record AF episodes ≥6 minutes in duration. Subjects were followed for 18 months with monthly remote interrogations and all events adjudicated by cardiologists. In subjects diagnosed with AF, medical records were reviewed to determine subsequent care. During a mean follow-up of 451 ± 185 days, the incidence of AF was 22.4% (95% confidence interval 17.2%–27.7%) with a mean time to detection of 141.3 ± 139.5 days. Among subjects newly diagnosed with AF, 76.4% were prescribed anticoagulation with either a novel OAC (n = 38) or warfarin (n = 4). In this large prospective cohort of subjects with CHA2DS2-VASc scores ≥2, 22.4% were newly diagnosed with AF and the majority of these subjects were given OACs, suggesting a potential role of ICMs in AF screening.