Objective: We aimed to determine the epidemiological characteristics of asymptomatic AF in elder community population (≥65 years old) to analyze the detection rate of different screening methods. Methods: The study was a prospective cohort study. The elder (≥65 years old) residents who voluntarily participated in free physical examination in Dalian community were selected. The participants were randomly divided into screening group (including intensive screening group and single screening group) and control group. The control group received interrogation, medical history collection and routine 12-lead electrocardiogram (ECG) examination. Screening group received an additional single-lead ambulatory ECG equipment worn for 5-7 days. Intensive screening group received two equal-length wearings in 2020 and 2021 respectively, while one screening group only wore once in 2020. Results: Finally 3 340 residents ((70.7±5.0) years old) which consisted of 1 488 males (44.55%) were enrolled. There were 1 945 residents in screening group, including 859 in intensive screening group and 1 086 in one-time screening group. The control group included 1 395 people. Detection rate of asymptomatic AF was significantly higher in screening group than control group (79(4.06%) vs. 24(1.72%), P<0.001). Higher detection rate was found in screening group than control group in AF risk factors (1 or 2-3) subgroups and CHA2DS2-VASc score (2-3 or≥4) subgroups (P<0.05). Additionally, no difference was found between intensive screening group and single screening group (42(4.89%) vs. 37(3.41%), P=0.100). Intensive screening increased detection rate (7(6.93%) vs. 1(0.58%), P=0.009) only in residents those with low thrombosis risk (CHA2DS2-VaSc<2). Conclusions: Screening in elderly (≥65 years old) can significantly improve the detection rate of asymptomatic AF by wearing single lead dynamic ECG device. The rate increased significantly with the increase of risk factors associated with AF by single screening. In addition, repeat screening of the same method may only improve detection rates in the group with low risk thrombotic scores and non-combination of AF risk factors.Screening methods that are appropriate for different populations may require further exploration.
目的： 探究大连市社区老年人群无症状房颤的患病率，分析不同的筛查方案在该人群中的检出率。 方法： 本研究为前瞻性队列研究。选取大连市社区自愿参加免费体检的≥65岁老年人。将参与体检人群随机分为筛查组（包括强化筛查组和1次筛查组）及对照组。对照组接受问诊、病史采集及常规12导联心电图检查，筛查组除上述内容外额外佩戴单导联动态心电设备，佩戴时间为5~7 d，强化筛查组在2020和2021年接受2次同等时长的佩戴，1次筛查组仅在2020年接受1次佩戴。 结果： 最终共纳入3 340人，年龄（70.7±5.0）岁，其中男性1 488例（44.55%）。筛查组1 945人，其中强化筛查组859人，1次筛查组1 086人。对照组纳入1 395人。对照组和筛查组房颤检出率分别为24例（1.72%）、79例（4.06%），筛查组房颤检出率高于对照组（P<0.001）。根据合并房颤危险因素的个数不同分组，在合并1个或2~3个危险因素亚组中，筛查组检出率均高于对照组，CHA2DS2-VASc评分2~3分及≥4分亚组中，筛查组检出率均高于对照组（P均<0.05）。强化筛查组及1次筛查组检出率差异无统计学意义［42例（4.89%）比37例（3.41%），P=0.100］。在CHA2DS2-VASc评分<2分亚组中，强化筛查组检出率高于1次筛查组［7例（6.93%）比1例（0.58%），P=0.009］。 结论： 针对65岁以上老年居民，佩戴单导联动态心电设备筛查可提高无症状房颤检出率；1次筛查的检出率随合并房颤危险因素的增多而升高；此外，同等强度的重复筛查可能仅在无房颤危险因素及血栓评分低危的群体中显著提高检出率。适合不同人群的筛查方案可能需要进一步探索。.