TOPLINE

In a Japanese study of older adults with hypertension using home ECG monitors, fewer than 1 in 4 visited a healthcare facility within 3 months of receiving a possible atrial fibrillation (AF) alert, and fewer than 1 in 5 underwent additional testing. Nearly half of participants with physician-confirmed AF remained undiagnosed at 12 months.

METHODOLOGY

• Researchers conducted a subanalysis of the prospective Omron Heart study in Japan from April 2022 through July 2023, enrolling 3820 adults aged 60 years and above with hypertension.
• Participants used a home blood pressure monitor equipped with a 30-second single-lead ECG twice daily for 3 months to detect AF.
• A total of 1700 participants (mean age, 66.8 years; 78% men) received at least one possible AF alert during the study period. 1682 and 1323 participants completed questionnaires at 3 and 12 months, respectively, assessing healthcare facility visits, additional testing, AF diagnosis, and anticoagulation initiation in response to device alerts.
• Six board-certified cardiologists independently reviewed ECG tracings; AF was confirmed when at least 2 of 3 randomly assigned cardiologists agreed, resulting in 220 participants with physician-adjudicated AF.

TAKEAWAY

• Of 1682 respondents at 3 months, 23.5% reported visiting a healthcare facility after an alert, 17.0% underwent additional testing, 2.1% received a new AF diagnosis, and 1.1% initiated anticoagulants.
• Among 175 participants with valid visit dates, the median time from first alert to medical visit was 28 days (mean, 36.4 days).
• Factors associated with lower odds of a hospital visit included age younger than 65 years (odds ratio [OR], 0.75; P = .016), current alcohol consumption (OR, 0.73; P = .018), absence of daily palpitations (OR, 0.69; P = .022), and absence of palpitations on the alert day (OR, 0.51; P = .010).
• Of 1700 patients who received AF alerts, 220 were confirmed to have AF by physician review, but only 115 (52.3%) of these 220 patients had a clinical AF diagnosis at 12 months, and 28 initiated anticoagulation therapy.

IN PRACTICE

“Given the well-established benefits of anticoagulation therapy for stroke prevention in AF, the failure to achieve clinical diagnosis in nearly half of confirmed AF cases represents a significant missed opportunity for intervention,” the authors wrote. “These findings underscore the need for improved systems to facilitate timely clinical evaluation following positive screening results from home monitoring devices.”

SOURCE

The study was led by Yusuke Kakei, Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. It was published online on July 17 in PLoS One.

LIMITATIONS

Response rates declined by 12 months. Hospital visits and AF diagnoses were self-reported. Time-to-visit analysis could not be performed. Generalizability was limited to adults aged ≥ 60 years with hypertension in Japan. The study did not collect data on reasons for not seeking care, healthcare system factors such as appointment availability or cost barriers, or device-specific accuracy data for this population.

DISCLOSURES

The study did not receive any funding. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.