Because atrial fibrillation significantly increases the risk of stroke, early detection and treatment is critical. The cost of traditional screening methods and lack of access to health care can be barriers to treatment, especially in rural areas. A study was conducted to determine whether mobile electrocardiogram (ECG) technology could be used in rural pharmacies to detect increased rates of stroke risk factors and previously undiagnosed atrial fibrillation.

Eligible walk-in customers at two rural pharmacies were screened for atrial fibrillation risk factors. Those with two or more risk factors were eligible for the study. A one-lead mobile ECG was performed, and each participant completed a questionnaire about demographics and medical history. Participants were then assigned an overall stroke risk score based on a commonly used calculator. All participants were given information about atrial fibrillation and referred to a health care provider, if indicated.

With mobile ECG screening, the rate of positive atrial fibrillation was 4% among the 250 participants. When mobile ECG reports were reviewed by three electrophysiologists-in an effort to determine the true prevalence rate of atrial fibrillation-the prevalence ranged between 1% and 8%. The average score on the stroke risk calculator was 2.68, which is higher than the reported national U.S. averages and the standard cutoff score of 2 for the recommendation of anticoagulant therapy.

The researchers point out that the readings taken by the one-lead mobile ECG device in their study weren't confirmed with a 12-lead ECG, and there was some disagreement among electrophysiologists when adjudicating the one-lead ECG. Also, the self-reporting of atrial fibrillation risk factors may have resulted in an over- or underestimation of prevalence.

The authors note that the results support the use of mobile ECG technology for community screening for undiagnosed atrial fibrillation in at-risk populations. They conclude that screenings may be best utilized in settings such as pharmacies and nursing homes, where health personnel are available to provide information and referrals.