INCIDENT ATRIAL FIBRILLATION AND THROMBO-EMBOLIC RISK - A REPORT FROM MAY MEASUREMENT MONTH 2019 SCREENING PROGRAMME IN BULGARIA.

OBJECTIVE: Despite the increased prevalence of atrial fibrillation (AF), data for the implementation of nationwide screening programmes are limited. The use of automatic devices for blood pressure measurement with AFIB technology during May Measurement Month (MMM) give a unique possibility to increase nationwide awareness about AF and stroke risk, to determine the prevalence of AF using a validated BP machine and its feasibility to identify new cases.

DESIGN AND METHOD: Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from participants during MMM2019 campaign in Bulgaria. BP was measured using a Microlife WatchBP Office BP monitor with patented AFIB algorithm in 2075 participants. A regression analysis was performed excluding all the subjects with previous AF to establish clinical factors significantly associated with incident AF.

RESULTS: The mean age of participants was 62.11 ± 14.9 years, 65% were female and 66% with known hypertension with a median duration of 11 years. Past history of AF was present in 223 (10,7%) and during the campaign additional 83 (4%) cases were identified. Among 306 subjects with AF, low-risk patients (i.e. CHA2DS2VASc score 0 in males or CHA2DS2VASc score 1 in females) was found in 5 (3.8%) males and in 13 (7.6%) females, respectively. We didn't found any significant difference in classical risk factors or cardiovascular diseases between the groups of previous and incident AF and both groups had identical CHA2DS2VASc score 3.56 vs 3.62, p = 0.8. On multivariable logistic regression CHF (P = 0.011), age 65-74 (P < 0.001) and = >75 (P < 0.001), diabetes (P < 0.01), previous stroke (P < 0.01) or vascular disease (P < 0.01), and prolonged history of hypertension with uncontrolled systolic BP during the screening (P = 0.012) or home systolic BP (P = 0.05) were significantly associated with incident AF.

CONCLUSIONS: The use of automatic devices for BP measurement with AFIB technology is feasible to identify a significant number of new AF cases, most with a high thrombo-embolic risk. Given the low OAC use recorded, greater efforts in AF detection and treatment are urgently needed to reduce the burden of stroke associated with this arrhythmia.