Screening for Atrial Fibrillation using a Smartphone-Based Electrocardiogram

<b>Background</b>: In Korea, stroke is the third most common cause of death, and 10–20% of ischemic strokes, which account for three-quarters of all strokes, are caused by atrial fibrillation (AF). Ischemic stroke can be prevented by treating AF with oral anticoagulation treatment. Therefore, the early detection and treatment of AF needs to be evaluated. We conducted AF screening in Koreans and evaluated the feasibility and acceptability of the screening program.<b>Methods</b>: This survey examined 2,422 participants in a community dementia screening program aged 60 years or older in the preliminary feasibility study, and 5,366 participants at 9 Senior Welfare Centers aged 60 years or older in the expanded feasibility study. AF screening was conducted using an automated single-lead electrocardiogram (SL-ECG) (Kardia Mobile, AliveCor, Mountain View, CA, USA). AF was confirmed with a 12-lead electrocardiogram in subjects classified as AF on the SL-ECG.<b>Results</b>: In the preliminary feasibility study, of the 2,422 subjects, 124 had AF on SL-ECG. The prevalence of AF was 3.0% (95% confidence interval [CI]: 2.4–3.8). The positive predictive value (PPV) of SL-ECG was 58.9% (95% CI: 50.1–67.1). Of the subjects diagnosed with AF, 65.8% (95% CI: 54.3–75.6) were newly diagnosed. In the expanded feasibility study, of the 5,366 subjects, 289 had AF on SL-ECG. The prevalence was 2.6% (95% CI: 2.2–3.1) and PPV of SL-ECG was 48.8% (95% CI: 43.1–54.5).<b>Conclusions</b>: AF screening using SL-ECG is feasible and acceptable for Korean population. The early detection and treatment of AF is necessary because AF is underdiagnosed and undertreated.