Introduction:
We performed an opportunisitic screening for atrial fibrillation (AF) at public pharmacies. The aim of this study was to analyze the adequate diagnostic assessment and treatment of patients consulting their primary care physician after screen-detection of AF.

Methods and results:

To perform a prospective, pharmacy-based single time point AF screening study a hand-held, single-lead electrocardiogram (SL-ECG) device was used. In total, 7107 elderly citizens (≥ 65 years) with a mean age of 74 ± 6 years were eligible for participation after obtainment of informed consent and assessment of medical history. Automated heart rhythm analyzes identified AF in 432 (6.1%) subjects who were advised to consult their primary care physician for further diagnostic assessment and treatment and were subsequently contacted 8 weeks after index measurement. Furthermore, we contacted the treating physicians to assess the initiation of oral anticoagulation (OAC) treatment after screen-detection of AF as well as the diagnostic approach in patients with newly diagnosed AF.

Of all patients with screen-detected AF, 83.3% (N=359) had consulted their primary care physician at 8-weeks follow-up. Baseline characteristics showed no significant difference in terms of age, sex, BMI, comorbidities, CHA₂DS₂-VASc-Score or frequency of preexisting anticoagulation between subjects who consulted their treating physician compared to those who did not. 38.2% (N=137) of patients consulting their treating physician had previously reported a history of AF. However, 28.4% (N=39) of these patients had no preexisting OAC treatment. In 48.7% (N=19) of these patients with a known history of AF consulting their primary care physician after screen-detection of AF no new OAC treatment was initiated while the CHA₂DS₂-VASc-Score was ≥ 2 in 94.7% (N=18) of patients in this subgroup. In contrast, 61.8% (N=222) of patients consulting their treating physician had no previous history of AF with 84.1% (N=187) of these patients having no preexisting OAC treatment. In this subgroup, in 89.3% (N=167) of the cases no new OAC treatment was initiated despite the CHA₂DS₂-VASc-Score being ≥ 2 in 95.2% (N=159) of the cases.

Furthermore, we evaluated the diagnostic assessment in patients with newly diagnosed AF. In patients with no history of AF consulting their primary care physician after screen-detection of AF (N=222), a 12-lead ECG was obtained in 71.6% (N=159) while Holter monitoring was performed in 39.2% (N=87) of the cases. Laboratory tests were done in 43.2% (N=96) of the cases. An echocardiographic examination was reported in only 2 cases (0.9%) by the primary care physicians. A referral to a specialist or hospital happened in 30.6% (N=68) and 6.3% (N=14) of the cases, respectively.

Conclusion:

While it was previously shown that pharmacy-based, automated AF screening with a SL-ECG device in elderly citizens is able to accurately identify subjects with AF, a significant number of patients consulting their primary care physicians after screen-detection of AF remain undertreated regarding the initiation of OAC. Furthermore, regarding patients with newly diagnosed AF, the recommended diagnostic approach is not met by primary care physicians in many cases.