Age-and-sex stratified prevalence of atrial fibrillation in rural Western India: Results of SMART-India, a population-based screening study. (1st April 2019)

• Record Type: Journal Article
• Authors: Soni, Apurv; Karna, Sunil; Fahey, Nisha; Sanghai, Saket; Patel, Harshil; Raithatha, Shyamsundar; Thanvi, Sunil; Nimbalkar, Somashekhar; Freedman, Ben; Allison, Jeroan; McManus, David D.
• Is Part Of: International journal of cardiology. Volume 280(2019)
• Page Start: 84
• Page End: 88
• Publication Date: 2019-04-01
• Subjects: Atrial fibrillation -- India -- Epidemiology -- ECG screening -- Mobile technology; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.12.016
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Early detection of Atrial Fibrillation (AF) is a public health priority across the globe because AF-related strokes are preventable. Despite an ongoing stroke epidemic in India, a public health strategy for AF screening and treatment is missing because the epidemiology of AF in India remains poorly defined. Methods: This population-based study used mobile technology to derive age and sex-stratified AF prevalence by screening 7 participants in each of six age and sex strata (age 40–55, 56–65, 65+, and male and female) from 50 villages (2100 participants). A health worker from each village used a handheld digital electrocardiogram (iECG) device (Kardia) to screen for AF on 3 separate days, and administered a questionnaire. All abnormal (AF or unclassified) iECGs were reviewed by the Indian cardiologist and AF determination confirmed by a US-based cardiac electrophysiologist. Results: Of the 2100 individuals enrolled, iECGs were collected from 2074 participants (98.8%) and 1947 (92.7%) participants responded to the questionnaire. AF was identified in 33 participants (1.6%), two-thirds on the first iECG. AF prevalence was higher among males (2.3% vs 1.0%, p = 0.03) and in older people (0.6%, 0.9%, 2.1%, 5.6%; p < 0.01). Conclusions: The prevalence of AF observed in our population-based sample is comparable to rates found in studies from North America and Western Europe and increases similarly with age. AF screening using village health workers in rural India is feasible and presents an opportunity for a strategy to address the stroke epidemic in India through primary prevention. Highlights: Prevalence of atrial fibrillation found in our study (1.6%) is at least 3-fold higher than previously reported in India. Community Health Workers are capable of performing AF screening using mobile point-of-care technologies. Multiple screenings, even over a short span of time, helps identify people with paroxysmal AF. Older people were more likely to have AF in comparison to younger people, mirroring trends observed in western countries.