Prevalence of atrial fibrillation and stroke risk assessment based on telemedicine screening tools in a primary healthcare setting

Background. Worldwide atrial fibrillation (AF) prevalence varies between 0.1% and 4.0%, and has been increasing. Little is known about the prevalence of AF in Brazil. Our objective was to estimate the prevalence of AF in several regions of Brazil using recordings of long-distance electrocardiogram (ECG) transmission. Methods: Patients from 125 outpatient general practitioner units covered by the telemedicine service of the Federal University of Sao Paulo were included. Only one ECG was considered per patient. A scripted telephone interview was also performed. We analyzed the data to project the prevalence of AF in the Brazilian population and estimate it for the year 2025. The overall AF prevalence was calculated based on ECGs from primary care units where patients went for routine visits. Results: Based on 676,621 ECG exams from January 2009 through April 2016, the mean age (+/- SD) of patients was 51.38 (+/- 19.05) years, with 57.5% being female. The 7-year period prevalence of AF was 2.2% (n = 14,968). The prevalence of AF countrywide was projected to be 1.5% in 2016 and 1.7% in 2025. In the subset of patients with AF who were interviewed (n = 301), 91 (30.2%) were not receiving any type of treatment for rate or rhythm control. Among patients interviewed, 189 (62.8%) were at high risk for stroke; only 28 (14.8%) were regular oral anticoagulant users. Conclusions: Our study highlights the importance of screening for AF in the primary care setting in Brazil and identifies important gaps in the treatment of AF in this population.