Edinburgh Napier University

  Background
Internationally, most atrial fibrillation (AF) management guidelines recommend opportunistic screening for AF in people aged ≥65 years, and oral anticoagulant (OAC) treatment for those at high stroke risk (CHA₂DS₂-VA ≥2). However, gaps remain in screening and treatment.
Methods and Results
General practitioners/nurses at practices in rural Australia(n=8) screened eligible patients (aged ≥65 years without AF) using a smartphone electrocardiogram during practice visits. eHealth tools included electronic prompts, guideline-based electronic decision support, and regular data reports. Clinical audit tools extracted deidentified data. Results were compared to an earlier study in metropolitan practices(n=8) and non-randomised control practices(n=69). Cost-effectiveness analysis compared population-based screening to no screening and included screening, treatment and hospitalisation costs for stroke and serious bleeding events. Patients (n=3,103, 34%) were screened (mean age 75.1±6.8 years, 47% male) and 36(1.2%) new AF cases were confirmed (mean age 77.0 years, 64% male, mean CHA₂DS₂-VA=3.2). OAC treatment rates for patients with CHA₂DS₂-VA≥2 were 82% (screen-detected) versus 74% (pre-existing AF)(p=NS), similar to metropolitan and non-randomised control practices. The incremental cost-effectiveness ratio (ICER) for population-based screening was AU$16,578/quality adjusted life year gained and AU$84,383/stroke prevented compared to no screening. National implementation would prevent 147 strokes/year. Increasing the proportion screened to 75% would prevent 177 additional strokes/year.
Conclusions
An AF screening program in rural practices, supported by eHealth tools, screened 34% of eligible patients and was cost-effective. OAC treatment rates were relatively high at baseline, trending upwards during the study. Increasing the proportion screened would prevent many more strokes with minimal ICER change. eHealth tools, including data reports, may be a valuable addition to future programs.