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Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Screening for atrial fibrillation (AF) is appealing because AF is common, when undiagnosed may increase stroke risk, and stroke is preventable with anticoagulants. This study assessed patient and primary care practitioner (PCP) acceptability of screening for AF using a 30-s single-lead electrocardiogram (SL-ECG) during outpatient visits.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Secondary analyses of a cluster randomized trial. All patients\u2009\u2265\u200965\u00a0years old without prevalent AF seen during a 1-year period and their PCPs. Screening using a SL-ECG was performed by medical assistants during check-in at 8 intervention sites among verbally consenting patients. PCPs were notified of \u201cpossible AF\u201d results; management was left to their discretion. Control practices continued with usual care. Following the trial, PCPs were surveyed about AF screening. Outcomes included screening uptake and results, and PCP preferences for screening.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Fifteen thousand three hundred ninety three patients were seen in intervention practices (mean age 73.9\u00a0years old, 59.7% female). Screening occurred at 78% of 38,502 individual encounters, and 91% of patients completed\u2009\u2265\u20091 screening. The positive predictive value of a \u201cPossible AF\u201d result (4.7% of SL-ECG tracings) at an encounter prior to a new AF diagnosis was 9.5%. Same-day 12-lead ECGs were slightly more frequent among intervention (7.0%) than control (6.2%) encounters (<jats:italic>p<\/jats:italic>\u2009=\u20090.07). Among the 208 PCPs completing a survey (73.6%; 78.9% intervention, 67.7% control), most favored screening for AF (87.2% vs. 83.6%, respectively), though SL-ECG screening was favored by intervention PCPs (86%) while control PCPs favored pulse palpation (65%). Both groups were less certain if AF screening should be done outside of office visits with patch monitors (47% unsure) or consumer devices (54% unsure).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Though the benefits and harms of screening for AF remain uncertain, most older patients underwent screening and PCPs were able to manage SL-ECG results, supporting the feasibility of routine primary care screening. PCPs exposed to a SL-ECG device preferred it over pulse palpation. PCPs were largely uncertain about AF screening done outside of practice visits.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>ClinicalTrials.gov NCT03515057. Registered May 3, 2018.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12875-023-02087-5","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T07:02:42Z","timestamp":1688108562000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Screening for undiagnosed atrial fibrillation using a single-lead electrocardiogram at primary care visits: patient uptake and practitioner perspectives from the VITAL-AF trial"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2297-9614","authenticated-orcid":false,"given":"Steven J.","family":"Atlas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Ashburner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchiao","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila H.","family":"Borowsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick T.","family":"Ellinor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David D.","family":"McManus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A.","family":"Lubitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Singer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,30]]},"reference":[{"issue":"9","key":"2087_CR1","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.1001\/archinte.1987.00370090041008","volume":"147","author":"PA Wolf","year":"1987","unstructured":"Wolf PA, Abbott RD, Kannel WB. 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The most recent continuing review was approved on November 21, 2022.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr. Atlas receives sponsored research support from Bristol Myers Squibb \/ Pfizer and American Heart Association 18SFRN34250007. He has consulted for Bristol Myers Squibb\/Pfizer and Fitbit. Dr. Ashburner is supported by NIH grant K01HL148506, American Heart Association 18SFRN34250007, and has received sponsored research support from Bristol Myers Squibb \/ Pfizer. Dr. McManus is supported by NIH grants R01HL137734 R01HL137794 R01HL141434 R01HL136660 R21AG060529 U54HL143541 U01HL146382 and receives sponsored research support from Apple, Bristol Myers Squibb \/ Pfizer, Boehringer Ingelheim, Flexcon, and has consulted for Bristol Myers Squibb \/ Pfizer, Heart Rhythm Society, Flexcon, and Avandia (Boston Biomedical) Associates. Dr. Ellinor is supported by grants from the National Institutes of Health (1RO1HL092577), by a grant from the American Heart Association Strategically Focused Research Networks (18SFRN34110082), and by a grant from the European Union (MAESTRIA 965286). Dr. Ellinor receives sponsored research support from Bayer AG and IBM Research; he has also served on advisory boards or consulted for Bayer AG, MyoKardia and Novartis. Dr. Lubitz is a full-time employee of Novartis as of July 18, 2022. Prior to his employment at Novartis and during this work he was supported by NIH grants R01HL139731, R01HL157635 and American Heart Association 18SFRN34250007. Dr. Lubitz previously received sponsored research support from Bristol Myers Squibb, Pfizer, Boehringer Ingelheim, Fitbit, Medtronic, Premier, and IBM, and has consulted for Bristol Myers Squibb, Pfizer, Blackstone Life Sciences, and Invitae.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"135"}}