Screening for Atrial Fibrillation in American Indian Adults in a Tribal Primary Care Clinic

Background: American Indian adults have a higher risk of atrial fibrillation (AF) compared with other racial groups. We implemented opportunistic screening to detect silent AF in American Indian adults attending a tribal health system using a mobile, single-lead ECG device. METHODS AND RESULTS: American Indian patients aged >= 50 years followed in a tribal primary care clinic with no history of AF underwent a 30-second ECG. A cardiologist overread all tracings to confirm the diagnosis of AF. After AF was confirmed, patients were referred to their primary care physician for initiation of anticoagulation. Patients seen over the same time period, who were not undergoing screening, served as controls. A total of 1019 patients received AF screening (mean age, 61.5 +/- 8.9 years, 62% women). Age and sex distribution of those screened was similar to the overall clinic population. New AF was diagnosed in 15 of 1019 (1.5%) patients screened versus 4 of 1267 (0.3%) patients who were not screened (mean difference, 1.2%; 95% CI, 0.3%-2.2%, P=0.002). Eight of 15 with new screen-detected AF were aged <65 years. Those with screen-detected AF were slightly older and had a higher CHA 2DS 2-VASc score than those without AF. Fourteen of 15 patients diagnosed with new AF had a CHA 2DS 2-VASc score =1 and initiated anticoagulation. CONCLUSIONS: Opportunistic, mobile single-lead ECG screening for AF is feasible in tribal clinics, and detects more AF than usual care, leading to appropriate initiation of anticoagulation. AF develops at a younger age in American Indian adults who would likely benefit from earlier AF screening. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03740477.

Automated summary

Opportunistic screening for atrial fibrillation using a mobile, single-lead ECG device in tribal health clinics can detect more cases of AF compared to usual care, leading to appropriate initiation of anticoagulation. AF develops at a younger age in American Indian adults who may benefit from earlier screening.