Purpose: Targeted screening for AF in a high-risk population of AF naïve, CKD patients with concomitant DM and cardiovascular disease
Methods: At Danderyd University Hospital, a specialized outpatient clinic has been developed, treating patients with combined CKD, cardiovascular disease and DM. A previous review of the patient cohort followed up at this clinic has shown an AF prevalence of 47 %.
The remaining patients (n=108), of the above group treated at the outpatient clinic were invited to participate in an AF screening study. Inclusion criteria were: manifest cardiovascular disease, DM and CKD, defined as macro-albuminuria or an estimated GFR < 60 ml/min/1.73m2. Patients were instructed to perform 30 second ECG registrations 2-4 daily for 14 days, using an ambulatory hand held ECG recording device. Patients with detected AF during follow-up were informed and offered oral anti coagulant treatment.
Results: Median age of 71 years (29- 88) and 43 % were female. In 4% of the screened patients previously undiagnosed AF was detected. In patients > 65 years the prevalence was 7 %. OAC treatment was accepted in all patients with new AF. The mean CHA2DS2-VASc score for the AF group was 4.6 and the HAS-BLED score 3.0.
Conclusion: The AF prevalence is high in this patient group with a combination of CKD, diabetes and cardiovascular disease. The high AF prevalence and overall high risk-scores may pose an increased risk for stroke. This may indicate that AF screening in these patients is motivated.