Serial 7-Day Electrocardiogram Patch Screening for AF in High-Risk Older Women by the CHARGE-AF Score

Jeffrey Y. Lin, Department of Medicine, Stanford University, Stanford, California, USA.
Joseph Larson, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Jenny Schoenberg, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Alejandra Sepulveda, Department of Medicine, Stanford University, Stanford, California, USA.
Lesley Tinker, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Matthew Wheeler, Department of Medicine, Stanford University, Stanford, California, USA.
Christine Albert, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
JoAnn E. Manson, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Gretchen Wells, Department of Medicine, University of Kentucky, Lexington, Kentucky, USA.
Lisa W. Martin, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Victor Froelicher, Department of Medicine, Stanford University, Stanford, California, USA.
Mike LaMonte, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA.
Charles Kooperberg, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Mark A. Hlatky, Department of Medicine, Stanford University, Stanford, California, USA.
Philip Greenland, Department of Medicine, Northwestern University, Evanston, Illinois, USA.
Marcia L. Stefanick, Department of Medicine, Stanford University, Stanford, California, USA.
Marco V. Perez, Department of Medicine, Stanford University, Stanford, California, USA. Electronic address: mvperez@stanford.edu.

Document Type

Journal Article

Publication Date

12-1-2022

Journal

JACC. Clinical electrophysiology

Volume

8

Issue

12

DOI

10.1016/j.jacep.2022.08.024

Keywords

Women’s Health Initiative; arrhythmias; atrial fibrillation; screening

Abstract

BACKGROUND: Asymptomatic atrial fibrillation (AF) is associated with an increased risk of stroke. The yield of serial electrocardiographic (ECG) screening for AF is unknown. OBJECTIVES: The aim of this study was to determine the frequency of AF detected by serial, 7-day ECG patch screenings in older women identified as having an elevated risk of AF according to the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology)-AF clinical prediction score. METHODS: Postmenopausal women with a 5-year predicted risk of new-onset AF ≥5% according to CHARGE-AF were recruited from the ongoing WHISH (Women's Health Initiative Strong and Healthy) randomized trial of a physical activity intervention. Participants with AF at baseline by self-report or medical records review were excluded. Screening with 7-day ECG patch monitors was performed at baseline, 6 months, and 12 months from study enrollment. RESULTS: On baseline monitoring, 2.5% of the cohort had AF detected, increasing to 3.7% by 6 months and 4.9% cumulatively by 12 months. Yield of patch screening was higher among participants with a higher (≥10%) CHARGE-AF score: 4.2% had AF detected at baseline, 5.9% at 6 months, and 7.2% at 12 months. Most participants with patch-identified AF never had a clinical diagnosis of AF (36 of 46 [78%]). CONCLUSIONS: Older women with an elevated CHARGE-AF score had a high prevalence of AF on 7-day ECG patch screening. Serial screening over 12 months substantially increased the detection of AF. These data can be useful in helping identify high-risk participants for enrollment in future studies of the management of asymptomatic AF.(Women's Health Initiative Silent Atrial Fibrillation Recording Study [WHISH STAR]; NCT05366803.).

Department

Medicine

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