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Yield of targeted AF screening in a high-risk cohort with chronic kidney disease, diabetes mellitus and cardiovascular disease

Session Poster session 2

Speaker Piotr Sobocinski-Doliwa

Event : EHRA 2018

  • Topic : arrhythmias and device therapy
  • Sub-topic : Prevalence and Incidence of Atrial Fibrillation
  • Session type : Poster Session

Authors : P Sobocinski-Doliwa (Stockholm,SE), JM Corander (Stockholm,SE), M Rosenqvist (Stockholm,SE), J Spaak (Stockholm,SE)

Authors:
P Sobocinski-Doliwa1 , JM Corander1 , M Rosenqvist1 , J Spaak1 , 1Karolinska Institute, Danderyd Hospital, Department of Clinical Sciences - Stockholm - Sweden ,

Citation:
European Heart Journal Supplements ( 2018 ) 20 ( Supplement 1 ), i163

Background/introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 3 %. The prevalence increases with age and is higher in subgroups with various comorbidities such as Chronic Kidney Disease (CKD) and Diabetes Mellitus (DM). CKD and DM also increase the risk of thromboembolic events.  Screening programs in older unselected patients (75-76 years) have shown to yield about 3 % new, previously untreated AF diagnoses.

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.



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