Intermittent vs continuous electrocardiogram event recording for detection of atrial fibrillation—Compliance and ease of use in an ambulatory elderly population

Background There are many atrial fibrillation (AF) screening devices available. Validation studies have mainly been performed in optimal settings in the young population. Hypothesis We aim to compare the yield of AF detection, compliance, and patient‐based experience in an ambulatory elderly population by using intermittent electrocardiogram (ECG) recordings and continuous event recording simultaneously. Methods The study participants were part of the STROKESTOP II study, a Swedish screening study for AF. All participants were 75/76 years of age, were clinically free of AF, and had N‐terminal pro b‐type natriuretic peptides levels ≥125 ng/L. AF screening was performed in parallel during a 2‐week period, using a continuous event recording device (R‐test 4; Novacor) and 30‐second intermittent recordings using a handheld ECG device (Zenicor II) four times daily. Participants were asked to fill out a questionnaire with regard to compliance and ease of use of the devices. Results During continuous event recording, 6% (n = 15/269) were diagnosed with AF and intermittent ECG detected AF in 2% (n = 5/269) of the participants (P = .002). No new cases of AF were detected using intermittent ECG monitoring only, but some episodes were detected in parallel for patients. On a graded ordinal scale of 1 to 5, with 1 reflecting “very easy to use”, continuous monitoring was graded 2 (interquartile range [IQR]: 1‐3) compared to intermittent 1 (IQR: 1‐1) (P