Screening for Atrial Fibrillation in Older Adults in Primary Care: A Cross-Sectional Pilot Study in Qatar

Screening for Atrial Fibrillation in Older Adults in Primary Care: A Cross-Sectional Pilot Study in Qatar | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Screening for Atrial Fibrillation in Older Adults in Primary Care: A Cross-Sectional Pilot Study in Qatar Ahmed Sameer Alnuaimi, Shahid Ahmad, Syed Abdulla, Babur Khan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5778095/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and its prevalence is increasing in aging populations. It is a leading cause of acute stroke, heart failure, sudden death, and other cardiovascular morbidities. AF is often asymptomatic and is frequently diagnosed late, typically after a patient presents with acute stroke. Early detection and treatment can prevent such life-threatening events, making AF screening a public health priority. However, diagnosing asymptomatic AF remains challenging. While international guidelines recommend AF screening, Qatar lacks documented prevalence data and formal screening programs. This study aimed to assess the feasibility of an AF screening program for older adults in Qatar. Methods A cross-sectional study was conducted among individuals aged ≥65 years registered with the Primary Health Care Corporation (PHCC)-Qatar, which serves approximately 70% of Qatar’s population. A simple random sample of 139 to 385 individuals was determined to ensure a sampling error of 5% to 3%, assuming a 10% AF prevalence. The participants underwent screening via standard ECG tracing that were reviewed independently by both the family physicians and a cardiologist. Results The prevalence of AF among the study population was 5.4%. Newly diagnosed cases accounted for 2% of the 249 participants screened. All newly detected patients had a CHA2DS2VASc scores indicating the need for anticoagulant therapy to reduce stroke risk. Furthermore, compared with cardiologists, the family physicians in primary care successfully identified 75% of AF cases through ECG. Conclusions If implemented nationally among individuals aged ≥65 years, the screening program could identify 747 undiagnosed AF cases among the 37,371. AF screening for individuals aged ≥75 years appears to offer a favorable cost‒benefit ratio, supporting the implementation of a targeted screening strategy in Qatar. Atrial Fibrillation Screening Primary Care Older Adults Stroke Prevention Qatar Public Health Background Atrial fibrillation (AF) is a cardiac arrhythmia characterized by supraventricular tachyarrhythmia with uncoordinated atrial electrical activation, leading to ineffective atrial contraction ( 1 ) . It is the most common arrhythmia encountered in clinical practice, affecting approximately 59.7 million people worldwide ( 2 ) . Aging is the most significant risk factor for AF. By 55 years of age, the lifetime risk of developing AF is 37% (3) . Additionally, males are nearly twice as likely as females to develop this condition ( 4 ) . AF is a major contributor to stroke, heart failure, sudden death, and cardiovascular morbidity ( 2 ) . It is associated with a fivefold increase in stroke risk, a threefold increase in heart failure risk, and a twofold increase in the risk of dementia and mortality ( 5 ) . Stroke remains a significant public health challenge worldwide, contributing substantially to morbidity and mortality ( 6 ) . AF is implicated in approximately 20–30% of ischemic strokes and 10% of hemorrhagic strokes ( 1 ) . Clinically, AF is often asymptomatic and is frequently diagnosed only when patients present with acute stroke ( 7 ) . Importantly, the risk of ischemic stroke in AF patients is comparable regardless of whether symptoms are present ( 8 ) . Early detection of AF is crucial, as timely management can significantly reduce associated risks. For patients with AF, oral anticoagulation (OAC) therapy can lower stroke risk by up to two-thirds, underscoring the importance of early diagnosis and intervention. Despite the benefits of early detection, asymptomatic AF remains a diagnostic challenge. International clinical guidelines and expert consensus strongly advocate for AF screening ( 1 , 9 , 10 ) . However, the optimal methods, locations, and target populations for screening should align with the specific needs of a healthcare system. In Qatar, AF was identified in 6.4% of patients who experienced a stroke ( 11 ) . Nevertheless, the true prevalence of AF in the general population has not been documented, and there are currently no formal AF screening programs. This study aims to assess the feasibility of an AF screening program targeting individuals aged 65 and older in Qatar's primary care setting via a 12-lead electrocardiogram (ECG). Methods Study setting The study was undertaken in Qatar’s publicly funded primary care organization, the Primary Health Care Corporation (PHCC). It has 31 primary health care centers across three geographical regions (central, northern and western) of the country. Approximately 70% of Qatar’s population is registered with the PHCC. Study population and data collection The study population consisted of individuals aged ≥ 65 years who were registered at a PHCC health center. Since participants were to be contacted by phone, the sampling frame was limited to those with an available phone number, representing more than 95% of the reference population. On the basis of literature, an AF prevalence rate of 10% was assumed. To achieve a 95% confidence level with a margin of error ranging from 5–3%, a sample size of 139 to 385 participants was deemed sufficient. This sample size was considered more than adequate for a pilot study. A list of all individuals meeting the inclusion criteria was extracted from the PHCC’s electronic medical records. A simple random sampling method was applied to select participants from the list. A nurse contacted potential participants by phone to inform them about the study. Those who agreed to participate were scheduled for an appointment at one of six designated PHCC health centers. At the appointment, a nurse obtained informed consent and collected demographic and clinical information, including age, sex, height, weight, blood pressure, and medical history. A 12-lead ECG was performed to screen for AF. The ECG results were reviewed independently by a family medicine physician and a cardiologist. In addition, the data required for calculating the CHA2DS2-VASc score (risk factors for AF) were recorded. If AF was confirmed, the participant was scheduled for a detailed follow-up appointment with a family physician. During this appointment, the diagnosis was explained, additional investigations were ordered as needed, and a referral to a cardiologist was arranged. Data analysis All the data were analyzed via the IBM Statistical Package for the Social Sciences (IBM SPSS) software V28. Basic descriptive statistics were used to describe the ECG results, diagnoses made by family physicians and cardiologists, and associated risk factors. Odds ratios were calculated to assess the strength of the associations between AF and various risk factors. Results A total of 249 individuals participated in the study. Overall, 7 individuals (2.8%) were diagnosed with AF, 5 (2%) had no previous history of AF, and 2 (0.8%) had a previous history of AF. Another 95 individuals (38.1%) had other diagnoses of EGC; 90 (36.1%) of them had no previous history of AF, and 5 (2%) had a previous history of AF (see Table 1). The electronic health records of PHCC-registered adults aged 65 years and older with valid phone numbers were reviewed for an existing diagnosis of AF. The prevalence rate of AF in the reference population was 5.4% (2,025 out of 37,371 individuals). On the basis of the results of the current study (2% probability for the screening program to identify new AF cases among individuals in this age group), it is anticipated that 747 previously undiagnosed AF cases could be detected. The number of undiagnosed cases is projected to range from 112 (at the most conservative end of the 95% confidence interval) to 1,420 (at the upper limit of the interval). As shown in Table 2, the family physician at the primary health center demonstrated a sensitivity of 71.4% in detecting AF through ECG compared with the gold-standard diagnosis by a cardiologist evaluating the same ECG. The specificity was nearly perfect at 99.2%. Given the very low prevalence of newly diagnosed AF in the study (pretest probability of only 2.8%), a positive AF diagnosis made by the family physician via ECG had a positive predictive value (PPV) of 71.4%. On the other hand, a negative ECG result from the same physician excluded an AF diagnosis with very high confidence, as reflected by a negative predictive value (NPV) of 99.2%. Similarly, as shown in Table 3, the most commonly reported risk factor in the study sample was high blood pressure (62.7%), followed by diabetes mellitus (57%) and female sex (45%). The participants aged 75 years and older constituted 28.5% of the sample. Vascular disease, including angina or myocardial infarction, was reported in 9.2% of individuals, whereas a history of stroke or transient ischemic attack was noted in 5.6%. The least frequently reported risk factor was congestive heart failure, which was present in only 1.2% of the sample. Table 4 shows that the strength of the associations between the seven risk factors and a positive diagnosis of AF, when tested independently, varied widely. There was no association observed for previous stroke or sex, whereas congestive heart failure was associated with up to a 20-fold increase in risk. However, owing to the rarity of AF, only the age criterion (being older than 74 years) demonstrated a statistically significant association, increasing the risk of having AF by 6.7 times. Discussion This cross-sectional study is exceptional in being the first conducted in Qatar and the Middle East to address the risk of AF in the general population. Although extensive clinical research on this topic has been carried out in secondary and tertiary care settings in the region, no studies have focused on the general population. Despite being designed as a pilot study owing to limited resources, the robust sampling methodology ensured reliable prevalence estimates. The current study demonstrated that systematic screening via ECG can identify new (previously undiagnosed) cases of AF in 2% of screened individuals aged 65 years and older. All newly detected patients had CHA2DS2-VASc scores ranging from 3 to 5, indicating that they were eligible for anticoagulant therapy ( 12 ) . Consumer-led screening, which is based on a history of AF recorded in electronic health records, revealed that 10 individuals (4%) had been previously labeled AF cases. However, only 2 of these individuals (0.8%) were confirmed to have AF on the new screening ECG. This highlights the need for prolonged rhythm monitoring to increase the sensitivity of AF detection. Using handheld ECG devices for two weeks or Holter patch monitoring for 5–7 days could significantly improve the sensitivity of detecting AF cases ( 12 ) . The overall prevalence of AF in this study was 6% among those older than 65 years, which is approximately half of the prevalence reported in Western populations, such as the United States (13.2%) (13) . This disparity may be attributed to the demographic composition of the study population, which consisted predominantly of Asian and, to a lesser extent, African individuals. AF incidence and incidence are reportedly lower among Asians and black individuals than among those of European ancestry ( 14 ) . The adoption of an AF screening program is projected to identify approximately 747 previously undiagnosed AF cases among the 37,371 individuals aged 65 years and older within the PHCC-served population. This number is anticipated to increase in the future due to the increasing life expectancy of the population. The criteria for CHA2DS2-VASc scoring, excluding female sex, which is used to evaluate the eligibility of AF patients for anticoagulation therapy, are also established risk factors for developing AF ( 14 ) . In the present study, diabetes and hypertension were present in more than half of the participants, whereas vascular disease and a history of stroke were reported in fewer than 10% of them. The strongest association with AF, however, was observed in individuals with congestive heart failure and those aged 75 years or older. Congestive heart failure increased the risk of AF by 20-fold, although this association did not achieve statistical significance due to the low prevalence of heart failure in the study population. Conversely, being older than 74 years significantly increased the risk of AF by 6.7 times compared with younger individuals. Only 1.1% of participants under 75 years of age presented with AF on ECG, whereas 7% of those aged 75 years or older presented with AF. Similar findings were reported in a secondary analysis of the VITAL-AF trial conducted in the United States ( 13 ) . Age would be a critical consideration in implementing a screening program in Qatar, as the older population is relatively small, thereby substantially increasing the cost-effectiveness of such a program. A large population-based study in China emphasized aging as the most significant risk factor for AF, alongside obesity, heart failure, vascular disease, hypertension, and diabetes. This study also highlighted a critical gap in preventing AF-related morbidity, as only 4% of eligible patients were prescribed anticoagulation therapy, despite a median CHA2DS2-VASc score of 2 in the population ( 15 ) . One key outcome of this study was the demonstrated ability of family physicians (FPs) in primary care, as frontline healthcare providers, to detect approximately three-quarters of AF cases through ECG interpretation compared with cardiologists. Moreover, FPs exhibited near-perfect specificity in excluding a possible diagnosis of AF. However, the sensitivity observed in this study may be subject to instability due to statistical bias arising from the small number of positive AF cases (only seven) identified. The overall diagnostic accuracy of screening ECGs for AF by family physicians was 98.1%, which aligns with findings reported in the literature ( 16 ) . Proposed strategies to increase the effectiveness of AF screening programs include fostering collaboration between FPs and cardiologists for ECG interpretation ( 17 ) , providing targeted training to improve diagnostic performance, or incorporating artificial intelligence (AI) technologies to support ECG assessment. These measures could significantly enhance the outcomes of a future AF screening program if implemented. The calculated 2% prevalence rate of newly detected AF cases in this pilot study is subject to the wide margin of error limitation, ranging from 0.3–3.8%. However, this limitation does not diminish its value in informing the decision to implement a screening program, particularly as the population of older adults in Qatar continues to grow. Furthermore, focusing on individuals aged 75 years and older appears to offer a favorable cost‒benefit ratio, supporting the recommendation for a targeted screening strategy at this time. In conclusion, this pilot study highlights the feasibility and potential benefits of systematic AF screening in Qatar's primary care setting, particularly among individuals aged 75 years and older. Despite the limitations of the small sample size and wide margin of error, the findings support targeted screening as a cost-effective strategy to detect undiagnosed AF patients, enabling timely intervention and reducing associated morbidity. Collaborative efforts, enhanced training, and AI integration could further improve screening accuracy and outcomes. Declarations Ethics approval and consent to participate The study presented a minimal risk of harm to the participants. The data collected was anonymized. None of the subjects’ personal information was available to the research team. An informed signed consent was secured from the study participants to assure their voluntary participation. Overall, the study was conducted with integrity according to generally accepted ethical principles in Belmont report and Helsinki’s declaration. The study protocol was reviewed and approved by the PHCC’s independent ethics committee (PHCC/DCR//2020/01/005). Consent for publication All the authors of the manuscript approved the current version of the manuscript for publication. Availability of data and materials The Primary Health Care Corporation, Qatar, has a data acquisition and sharing policy that prohibits data release without an agreement between the relevant parties. A request to share data can be processed by submitting a legitimate request to PHCC, Qatar. Competing interests I declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding This project was funded by the Primary Health Care Corporation (PHCC), Qatar. Authors' contributions ASA: conception / design of the work, analysis / interpretation of data, drafted the work, revised the manuscript SAh: conception / design of the work, revised the manuscript SAb: acquisition of data, revised the manuscript BK: acquisition of data, revised the manuscript ZA: acquisition of data, revised the manuscript TH: acquisition, interpretation of data, revised the manuscript MAS: conception / design of the work, drafted the work, revised the manuscript Acknowledgements The research team would like to acknowledge the dedication of the data collectors. The study participants deserve our gratitude for offering their precious time to participate. Authors' information (optional) Dr. Ahmed Sameer Alnuaimi (Corresponding Author) Primary Health Care Corporation P.O. Box 26555, Doha, Qatar Email: [email protected] Phone: +97466488998 Dr. Shahid Ahmad Primary Health Care Corporation P.O. Box 26555, Doha, Qatar Email: [email protected] Dr. Syed Abdulla Primary Health Care Corporation P.O. Box 26555, Doha, Qatar Email: [email protected] Dr. Babur Khan Primary Health Care Corporation P.O. Box 26555, Doha, Qatar Email: [email protected] Dr. Zaheer Ahmed Primary Health Care Corporation P.O. Box 26555, Doha, Qatar Email: [email protected] Dr. Tahir Hameed Heart Hospital Hamad Medical Corporation, Doha, Qatar Email: [email protected] Dr. Mohamed Ahmed Syed Primary Health Care Corporation P.O. Box 26555, Doha, Qatar Email: [email protected] References Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373–498. Li H, Song X, Liang Y, Bai X, Liu-Huo Tang C, et al. Global, regional, and national burden of disease study of atrial fibrillation/flutter, 1990–2019: results from a global burden of disease study, 2019. BMC Public Health. 2022;22(1):2015. Weng LC, Preis SR, Hulme OL, Larson MG, Choi SH, Wang B, et al. Genetic Predisposition, Clinical Risk Factor Burden, and Lifetime Risk of Atrial Fibrillation. Circulation. 2018;137(10):1027–38. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 2014;6:213–20. Vermond RA, Van Gelder IC, Crijns HJ, Rienstra M. Does Myocardial Infarction Beget Atrial Fibrillation and Atrial Fibrillation Beget Myocardial Infarction? Circulation. 2015;131(21):1824–6. Katan M, Luft A. Global Burden of Stroke. Semin Neurol. 2018;38(2):208–11. Jaakkola J, Mustonen P, Kiviniemi T, Hartikainen JE, Palomäki A, Hartikainen P, et al. Stroke as the First Manifestation of Atrial Fibrillation. PLoS ONE. 2016;11(12):e0168010. Healey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366(2):120–9. Freedman B, Camm J, Calkins H, Healey JS, Rosenqvist M, Wang J, et al. Screening for Atrial Fibrillation: A Report of the AF-SCREEN International Collaboration. Circulation. 2017;135(19):1851–67. Mairesse GH, Moran P, Van Gelder IC, Elsner C, Rosenqvist M, Mant J, et al. Screening for atrial fibrillation: a European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE). Europace. 2017;19(10):1589–623. Imam YZ, Kamran S, Akhtar N, Deleu D, Singh R, Malik RA, et al. Incidence, clinical features and outcomes of atrial fibrillation and stroke in Qatar. Int J Stroke. 2020;15(1):85–9. Kim T-H, Yang P-S, Kim D, Yu HT, Uhm J-S, Kim J-Y, et al. CHA2DS2-VASc Score for Identifying Truly Low-Risk Atrial Fibrillation for Stroke. Stroke. 2017;48(11):2984–90. Khurshid S, Ashburner JM, Ellinor PT, McManus DD, Atlas SJ, Singer DE, et al. Prevalence and Incidence of Atrial Fibrillation Among Older Primary Care Patients. JAMA Netw Open. 2023;6(2):e2255838–e. Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century. Circul Res. 2020;127(1):4–20. Boriani G. The Epidemiologic Threat of Atrial Fibrillation: Need for Secondary, Primary, and Primordial Prevention. Chest. 2015;147(1):9–10. Compiet SAM, Willemsen RTA, Konings KTS, Stoffers H. Competence of general practitioners in requesting and interpreting ECGs - a case vignette study. Neth Heart J. 2018;26(7–8):377–84. Somsen GA. The role of ECG screening in primary care; a call for collaboration between general practitioner and cardiologist. Neth Heart J. 2020;28(4):190–1. Tables Table 1 : Frequency distribution of the final diagnoses by cardiologist assessment of current ECGs and past history of AF in the electronic health records. Final diagnosis N % 95% Confidence Interval (%) No abnormal ECG findings (including AF) 144 57.8 Newly diagnosed (current ECG) 5 2.0 0.3-3.8 Past history of AF confirmed by current ECG 2 0.8 0.02-0.29 Past history of AF with negative current ECG 3 1.2 0.4-3.5 Past history of AF presenting with other ECG findings apart of AF 5 2.0 0.3-3.8 Other positive ECG findings 90 36.1 30.2-42.1 Total 249 100.0 Table 2 : ECG findings of the family medicine physician compared with those of a cardiologist. family physician ECG findings Cardiologist ECG review Normal AF Other positive findings Total Normal 136 0 32 168 AF 1 5 1 7 Other positive findings 10 2 62 74 Total 147 7 95 249 AF diagnosis by the family physician is associated with the following test performance characteristics: Sensitivity=71.4% Specificity=99.2% PPV=71.4% NPV=99.2% Pretest probability=2.8% Accuracy = 98.1 Table 3 : The prevalence rates of selected risk factors. Positive risk factors for AF (N=249) N % 95% Confidence Interval (%) High Blood Pressure 156 62.7 56.6-68.7 Diabetes Mellitus 142 57.0 50.9-63.2 Female sex 112 45.0 38.8-51.2 Age 75+ 71 28.5 22.9-34.1 Vascular Disease (Angina, myocardial infarction) 23 9.2 5.6-12.8 Previous Stroke or Transient Ischemic Attack (TIA) 14 5.6 2.8-8.5 Congestive Heart Failure 3 1.2 0.4-3.5 Table 4 : Risk of having AF according to selected risk factors. Confirmed Atrial Fibrillation (Cardiologist) Negative Positive Total N % N % N % OR 95% CI (OR) P 1. Congestive Heart Failure 20 (1.6 - 251.9) 0.08[NS] Negative 240 97.6 6 2.4 246 100.0 Positive 2 66.7 1 33.3 3 100.0 2. Age group 6.7 (1.3 - 35.2) 0.021 65-74 176 98.9 2 1.1 178 100.0 75+ 66 93.0 5 7.0 71 100.0 3. Vascular Disease (Angina, myocardial infarction) 4.2 (0.8 - 23) 0.13[NS] Negative 221 97.8 5 2.2 226 100.0 Positive 21 91.3 2 8.7 23 100.0 4. High Blood Pressure 3.7 (0.4 - 31.1) 0.26[NS] Negative 92 98.9 1 1.1 93 100.0 Positive 150 96.2 6 3.8 156 100.0 5. Diabetes Mellitus 1.9 (0.4 - 10.1) 0.48[NS] Negative 105 98.1 2 1.9 107 100.0 Positive 137 96.5 5 3.5 142 100.0 6. Previous Stroke or Transient Ischemic Attack (TIA) ** ** 1[NS] Negative 228 97.0 7 3.0 235 100.0 Positive 14 100.0 0 0.0 14 100.0 7. Sex 1[NS] 1.1 (0.2 - 5) Female 109 97.3 3 2.7 112 100.0 Male 133 97.1 4 2.9 137 100.0 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5778095","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":405614987,"identity":"821b2ee9-b385-4a1f-a49a-4508bbb3f149","order_by":0,"name":"Ahmed Sameer Alnuaimi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYDACCSDmMTjAwMDefADElSFBC8+xBBCXh0gtDEAtEjkGDGA2IcA/uzvxwZuCO/byDTmfX92oseBhYD98dANeS+6c3Ww4x+BZ4oYDZ7dZ5xwDOownLe0GXmtu5G6T5jE4nGDA2LvNOIcNqEWCxwyvFvkbudt/A7XYyzfzPDPO+UeEFgOgLcxALYwNx3iYH+e2EaHF8EbuZsk5BocTN5xhM2PO7ZPgYSPkF7kbuRs/vPkDdNj8x48/53yrk+NnP3wMv/eRAJsEmCRWOQgwfyBF9SgYBaNgFIwcAAAqJUxacqi9KwAAAABJRU5ErkJggg==","orcid":"","institution":"Primary Health Care Corporation","correspondingAuthor":true,"prefix":"","firstName":"Ahmed","middleName":"Sameer","lastName":"Alnuaimi","suffix":""},{"id":405614988,"identity":"033b523f-b3c7-462f-a09b-525e657e6360","order_by":1,"name":"Shahid Ahmad","email":"","orcid":"","institution":"Primary Health Care Corporation","correspondingAuthor":false,"prefix":"","firstName":"Shahid","middleName":"","lastName":"Ahmad","suffix":""},{"id":405614989,"identity":"22ecf4f0-3178-4fc1-80bd-c976411cbeff","order_by":2,"name":"Syed Abdulla","email":"","orcid":"","institution":"Primary Health Care Corporation","correspondingAuthor":false,"prefix":"","firstName":"Syed","middleName":"","lastName":"Abdulla","suffix":""},{"id":405614991,"identity":"892a3b83-a032-4f4e-9e1d-763cc39a0dee","order_by":3,"name":"Babur Khan","email":"","orcid":"","institution":"Primary Health Care Corporation","correspondingAuthor":false,"prefix":"","firstName":"Babur","middleName":"","lastName":"Khan","suffix":""},{"id":405614993,"identity":"7923e86b-38ff-4bde-9b68-4387c3c155bc","order_by":4,"name":"Zaheer Ahmed","email":"","orcid":"","institution":"Primary Health Care Corporation","correspondingAuthor":false,"prefix":"","firstName":"Zaheer","middleName":"","lastName":"Ahmed","suffix":""},{"id":405614994,"identity":"c7b98723-f716-490e-984c-4fd631cc6cc2","order_by":5,"name":"Tahir Hameed","email":"","orcid":"","institution":"Heart Hospital Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Tahir","middleName":"","lastName":"Hameed","suffix":""},{"id":405614996,"identity":"d2f1c2eb-cd74-40b6-94ba-89f1d7ad036e","order_by":6,"name":"Mohamed Ahmed Syed","email":"","orcid":"","institution":"Primary Health Care Corporation","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Ahmed","lastName":"Syed","suffix":""}],"badges":[],"createdAt":"2025-01-07 05:38:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5778095/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5778095/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79609715,"identity":"3ed186a2-af9f-4c4a-9d5f-3bfaabb8cc6f","added_by":"auto","created_at":"2025-03-31 17:09:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":990870,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5778095/v1/bcd5261d-a166-453c-890a-a82db7928d94.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Screening for Atrial Fibrillation in Older Adults in Primary Care: A Cross-Sectional Pilot Study in Qatar","fulltext":[{"header":"Background","content":"\u003cp\u003eAtrial fibrillation (AF) is a cardiac arrhythmia characterized by supraventricular tachyarrhythmia with uncoordinated atrial electrical activation, leading to ineffective atrial contraction\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. It is the most common arrhythmia encountered in clinical practice, affecting approximately 59.7\u0026nbsp;million people worldwide\u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e. Aging is the most significant risk factor for AF. By 55 years of age, the lifetime risk of developing AF is 37%\u003csup\u003e(3)\u003c/sup\u003e. Additionally, males are nearly twice as likely as females to develop this condition\u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAF is a major contributor to stroke, heart failure, sudden death, and cardiovascular morbidity\u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e. It is associated with a fivefold increase in stroke risk, a threefold increase in heart failure risk, and a twofold increase in the risk of dementia and mortality\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e. Stroke remains a significant public health challenge worldwide, contributing substantially to morbidity and mortality\u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e. AF is implicated in approximately 20\u0026ndash;30% of ischemic strokes and 10% of hemorrhagic strokes\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eClinically, AF is often asymptomatic and is frequently diagnosed only when patients present with acute stroke\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. Importantly, the risk of ischemic stroke in AF patients is comparable regardless of whether symptoms are present\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. Early detection of AF is crucial, as timely management can significantly reduce associated risks. For patients with AF, oral anticoagulation (OAC) therapy can lower stroke risk by up to two-thirds, underscoring the importance of early diagnosis and intervention.\u003c/p\u003e \u003cp\u003eDespite the benefits of early detection, asymptomatic AF remains a diagnostic challenge. International clinical guidelines and expert consensus strongly advocate for AF screening\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e. However, the optimal methods, locations, and target populations for screening should align with the specific needs of a healthcare system.\u003c/p\u003e \u003cp\u003eIn Qatar, AF was identified in 6.4% of patients who experienced a stroke\u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e. Nevertheless, the true prevalence of AF in the general population has not been documented, and there are currently no formal AF screening programs. This study aims to assess the feasibility of an AF screening program targeting individuals aged 65 and older in Qatar's primary care setting via a 12-lead electrocardiogram (ECG).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eStudy setting\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The study was undertaken in Qatar\u0026rsquo;s publicly funded primary care organization, the Primary Health Care Corporation (PHCC). It has 31 primary health care centers across three geographical regions (central, northern and western) of the country. Approximately 70% of Qatar\u0026rsquo;s population is registered with the PHCC.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy population and data collection\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe study population consisted of individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years who were registered at a PHCC health center. Since participants were to be contacted by phone, the sampling frame was limited to those with an available phone number, representing more than 95% of the reference population. On the basis of literature, an AF prevalence rate of 10% was assumed. To achieve a 95% confidence level with a margin of error ranging from 5\u0026ndash;3%, a sample size of 139 to 385 participants was deemed sufficient. This sample size was considered more than adequate for a pilot study.\u003c/p\u003e \u003cp\u003eA list of all individuals meeting the inclusion criteria was extracted from the PHCC\u0026rsquo;s electronic medical records. A simple random sampling method was applied to select participants from the list. A nurse contacted potential participants by phone to inform them about the study. Those who agreed to participate were scheduled for an appointment at one of six designated PHCC health centers.\u003c/p\u003e \u003cp\u003eAt the appointment, a nurse obtained informed consent and collected demographic and clinical information, including age, sex, height, weight, blood pressure, and medical history. A 12-lead ECG was performed to screen for AF. The ECG results were reviewed independently by a family medicine physician and a cardiologist. In addition, the data required for calculating the CHA2DS2-VASc score (risk factors for AF) were recorded.\u003c/p\u003e \u003cp\u003eIf AF was confirmed, the participant was scheduled for a detailed follow-up appointment with a family physician. During this appointment, the diagnosis was explained, additional investigations were ordered as needed, and a referral to a cardiologist was arranged.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAll the data were analyzed via the IBM Statistical Package for the Social Sciences (IBM SPSS) software V28. Basic descriptive statistics were used to describe the ECG results, diagnoses made by family physicians and cardiologists, and associated risk factors. Odds ratios were calculated to assess the strength of the associations between AF and various risk factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 249 individuals participated in the study. Overall, 7 individuals (2.8%) were diagnosed with AF, 5 (2%) had no previous history of AF, and 2 (0.8%) had a previous history of AF. Another 95 individuals (38.1%) had other diagnoses of EGC; 90 (36.1%) of them had no previous history of AF, and 5 (2%) had a previous history of AF (see Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eThe electronic health records of PHCC-registered adults aged 65 years and older with valid phone numbers were reviewed for an existing diagnosis of AF. The prevalence rate of AF in the reference population was 5.4% (2,025 out of 37,371 individuals). On the basis of the results of the current study (2% probability for the screening program to identify new AF cases among individuals in this age group), it is anticipated that 747 previously undiagnosed AF cases could be detected. The number of undiagnosed cases is projected to range from 112 (at the most conservative end of the 95% confidence interval) to 1,420 (at the upper limit of the interval).\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;2, the family physician at the primary health center demonstrated a sensitivity of 71.4% in detecting AF through ECG compared with the gold-standard diagnosis by a cardiologist evaluating the same ECG. The specificity was nearly perfect at 99.2%. Given the very low prevalence of newly diagnosed AF in the study (pretest probability of only 2.8%), a positive AF diagnosis made by the family physician via ECG had a positive predictive value (PPV) of 71.4%. On the other hand, a negative ECG result from the same physician excluded an AF diagnosis with very high confidence, as reflected by a negative predictive value (NPV) of 99.2%.\u003c/p\u003e \u003cp\u003eSimilarly, as shown in Table\u0026nbsp;3, the most commonly reported risk factor in the study sample was high blood pressure (62.7%), followed by diabetes mellitus (57%) and female sex (45%). The participants aged 75 years and older constituted 28.5% of the sample. Vascular disease, including angina or myocardial infarction, was reported in 9.2% of individuals, whereas a history of stroke or transient ischemic attack was noted in 5.6%. The least frequently reported risk factor was congestive heart failure, which was present in only 1.2% of the sample.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;4 shows that the strength of the associations between the seven risk factors and a positive diagnosis of AF, when tested independently, varied widely. There was no association observed for previous stroke or sex, whereas congestive heart failure was associated with up to a 20-fold increase in risk. However, owing to the rarity of AF, only the age criterion (being older than 74 years) demonstrated a statistically significant association, increasing the risk of having AF by 6.7 times.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional study is exceptional in being the first conducted in Qatar and the Middle East to address the risk of AF in the general population. Although extensive clinical research on this topic has been carried out in secondary and tertiary care settings in the region, no studies have focused on the general population. Despite being designed as a pilot study owing to limited resources, the robust sampling methodology ensured reliable prevalence estimates.\u003c/p\u003e \u003cp\u003eThe current study demonstrated that systematic screening via ECG can identify new (previously undiagnosed) cases of AF in 2% of screened individuals aged 65 years and older. All newly detected patients had CHA2DS2-VASc scores ranging from 3 to 5, indicating that they were eligible for anticoagulant therapy\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e. Consumer-led screening, which is based on a history of AF recorded in electronic health records, revealed that 10 individuals (4%) had been previously labeled AF cases. However, only 2 of these individuals (0.8%) were confirmed to have AF on the new screening ECG. This highlights the need for prolonged rhythm monitoring to increase the sensitivity of AF detection. Using handheld ECG devices for two weeks or Holter patch monitoring for 5\u0026ndash;7 days could significantly improve the sensitivity of detecting AF cases\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe overall prevalence of AF in this study was 6% among those older than 65 years, which is approximately half of the prevalence reported in Western populations, such as the United States (13.2%)\u003csup\u003e(13)\u003c/sup\u003e. This disparity may be attributed to the demographic composition of the study population, which consisted predominantly of Asian and, to a lesser extent, African individuals. AF incidence and incidence are reportedly lower among Asians and black individuals than among those of European ancestry\u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe adoption of an AF screening program is projected to identify approximately 747 previously undiagnosed AF cases among the 37,371 individuals aged 65 years and older within the PHCC-served population. This number is anticipated to increase in the future due to the increasing life expectancy of the population.\u003c/p\u003e \u003cp\u003eThe criteria for CHA2DS2-VASc scoring, excluding female sex, which is used to evaluate the eligibility of AF patients for anticoagulation therapy, are also established risk factors for developing AF\u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e. In the present study, diabetes and hypertension were present in more than half of the participants, whereas vascular disease and a history of stroke were reported in fewer than 10% of them. The strongest association with AF, however, was observed in individuals with congestive heart failure and those aged 75 years or older.\u003c/p\u003e \u003cp\u003eCongestive heart failure increased the risk of AF by 20-fold, although this association did not achieve statistical significance due to the low prevalence of heart failure in the study population. Conversely, being older than 74 years significantly increased the risk of AF by 6.7 times compared with younger individuals. Only 1.1% of participants under 75 years of age presented with AF on ECG, whereas 7% of those aged 75 years or older presented with AF. Similar findings were reported in a secondary analysis of the VITAL-AF trial conducted in the United States\u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAge would be a critical consideration in implementing a screening program in Qatar, as the older population is relatively small, thereby substantially increasing the cost-effectiveness of such a program. A large population-based study in China emphasized aging as the most significant risk factor for AF, alongside obesity, heart failure, vascular disease, hypertension, and diabetes. This study also highlighted a critical gap in preventing AF-related morbidity, as only 4% of eligible patients were prescribed anticoagulation therapy, despite a median CHA2DS2-VASc score of 2 in the population\u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOne key outcome of this study was the demonstrated ability of family physicians (FPs) in primary care, as frontline healthcare providers, to detect approximately three-quarters of AF cases through ECG interpretation compared with cardiologists. Moreover, FPs exhibited near-perfect specificity in excluding a possible diagnosis of AF. However, the sensitivity observed in this study may be subject to instability due to statistical bias arising from the small number of positive AF cases (only seven) identified. The overall diagnostic accuracy of screening ECGs for AF by family physicians was 98.1%, which aligns with findings reported in the literature\u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e. Proposed strategies to increase the effectiveness of AF screening programs include fostering collaboration between FPs and cardiologists for ECG interpretation\u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/sup\u003e, providing targeted training to improve diagnostic performance, or incorporating artificial intelligence (AI) technologies to support ECG assessment. These measures could significantly enhance the outcomes of a future AF screening program if implemented.\u003c/p\u003e \u003cp\u003eThe calculated 2% prevalence rate of newly detected AF cases in this pilot study is subject to the wide margin of error limitation, ranging from 0.3\u0026ndash;3.8%. However, this limitation does not diminish its value in informing the decision to implement a screening program, particularly as the population of older adults in Qatar continues to grow. Furthermore, focusing on individuals aged 75 years and older appears to offer a favorable cost‒benefit ratio, supporting the recommendation for a targeted screening strategy at this time.\u003c/p\u003e \u003cp\u003eIn conclusion, this pilot study highlights the feasibility and potential benefits of systematic AF screening in Qatar's primary care setting, particularly among individuals aged 75 years and older. Despite the limitations of the small sample size and wide margin of error, the findings support targeted screening as a cost-effective strategy to detect undiagnosed AF patients, enabling timely intervention and reducing associated morbidity. Collaborative efforts, enhanced training, and AI integration could further improve screening accuracy and outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eThe study presented a minimal risk of harm to the participants. The data collected was anonymized. None of the subjects\u0026rsquo; personal information was available to the research team. An informed signed consent was secured from the study participants to assure their voluntary participation. Overall, the study was conducted with integrity according to generally accepted ethical principles in Belmont report and Helsinki\u0026rsquo;s declaration. The study protocol was reviewed and approved by the PHCC\u0026rsquo;s independent ethics committee (PHCC/DCR//2020/01/005).\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eAll the authors of the manuscript approved the current version of the manuscript for publication.\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eThe Primary Health Care Corporation, Qatar, has a data acquisition and sharing policy that prohibits data release without an agreement between the relevant parties. A request to share data can be processed by submitting a legitimate request to PHCC, Qatar.\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eI declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThis project was funded by the Primary Health Care Corporation (PHCC), Qatar.\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026apos; contributions\u003c/h3\u003e\n\u003cp\u003eASA: conception / design of the work, analysis / interpretation of data, drafted the work, revised the manuscript\u003c/p\u003e\n\u003cp\u003eSAh: conception / design of the work, revised the manuscript\u003c/p\u003e\n\u003cp\u003eSAb: acquisition of data, revised the manuscript\u003c/p\u003e\n\u003cp\u003eBK: acquisition of data, revised the manuscript\u003c/p\u003e\n\u003cp\u003eZA: acquisition of data, revised the manuscript\u003c/p\u003e\n\u003cp\u003eTH: acquisition, interpretation of data, revised the manuscript\u003c/p\u003e\n\u003cp\u003eMAS: conception / design of the work, drafted the work, revised the manuscript\u003c/p\u003e\n\u003ch3\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eThe research team would like to acknowledge the dedication of the data collectors. The study participants deserve our gratitude for offering their precious time to participate.\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026apos; information (optional)\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Ahmed Sameer Alnuaimi\u003c/strong\u003e (Corresponding Author)\u003c/p\u003e\n\u003cp\u003ePrimary Health Care Corporation\u003c/p\u003e\n\u003cp\u003eP.O. Box 26555, Doha, Qatar\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003ePhone: +97466488998\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Shahid Ahmad\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary Health Care Corporation\u003c/p\u003e\n\u003cp\u003eP.O. Box 26555, Doha, Qatar\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Syed Abdulla\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary Health Care Corporation\u003c/p\u003e\n\u003cp\u003eP.O. Box 26555, Doha, Qatar\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Babur Khan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary Health Care Corporation\u003c/p\u003e\n\u003cp\u003eP.O. Box 26555, Doha, Qatar\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Zaheer Ahmed\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary Health Care Corporation\u003c/p\u003e\n\u003cp\u003eP.O. Box 26555, Doha, Qatar\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Tahir Hameed\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHeart Hospital\u003c/p\u003e\n\u003cp\u003eHamad Medical Corporation, Doha, Qatar\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Mohamed Ahmed Syed\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary Health Care Corporation\u003c/p\u003e\n\u003cp\u003eP.O. Box 26555, Doha, Qatar\u003c/p\u003e\n\u003cp\u003eEmail: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstr\u0026ouml;m-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373\u0026ndash;498.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi H, Song X, Liang Y, Bai X, Liu-Huo Tang C, et al. Global, regional, and national burden of disease study of atrial fibrillation/flutter, 1990\u0026ndash;2019: results from a global burden of disease study, 2019. BMC Public Health. 2022;22(1):2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeng LC, Preis SR, Hulme OL, Larson MG, Choi SH, Wang B, et al. Genetic Predisposition, Clinical Risk Factor Burden, and Lifetime Risk of Atrial Fibrillation. Circulation. 2018;137(10):1027\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 2014;6:213\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVermond RA, Van Gelder IC, Crijns HJ, Rienstra M. Does Myocardial Infarction Beget Atrial Fibrillation and Atrial Fibrillation Beget Myocardial Infarction? Circulation. 2015;131(21):1824\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatan M, Luft A. Global Burden of Stroke. Semin Neurol. 2018;38(2):208\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJaakkola J, Mustonen P, Kiviniemi T, Hartikainen JE, Palom\u0026auml;ki A, Hartikainen P, et al. Stroke as the First Manifestation of Atrial Fibrillation. PLoS ONE. 2016;11(12):e0168010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealey JS, Connolly SJ, Gold MR, Israel CW, Van Gelder IC, Capucci A, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366(2):120\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreedman B, Camm J, Calkins H, Healey JS, Rosenqvist M, Wang J, et al. Screening for Atrial Fibrillation: A Report of the AF-SCREEN International Collaboration. Circulation. 2017;135(19):1851\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMairesse GH, Moran P, Van Gelder IC, Elsner C, Rosenqvist M, Mant J, et al. Screening for atrial fibrillation: a European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulaci\u0026oacute;n Card\u0026iacute;aca y Electrofisiolog\u0026iacute;a (SOLAECE). Europace. 2017;19(10):1589\u0026ndash;623.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImam YZ, Kamran S, Akhtar N, Deleu D, Singh R, Malik RA, et al. Incidence, clinical features and outcomes of atrial fibrillation and stroke in Qatar. Int J Stroke. 2020;15(1):85\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim T-H, Yang P-S, Kim D, Yu HT, Uhm J-S, Kim J-Y, et al. CHA2DS2-VASc Score for Identifying Truly Low-Risk Atrial Fibrillation for Stroke. Stroke. 2017;48(11):2984\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhurshid S, Ashburner JM, Ellinor PT, McManus DD, Atlas SJ, Singer DE, et al. Prevalence and Incidence of Atrial Fibrillation Among Older Primary Care Patients. JAMA Netw Open. 2023;6(2):e2255838\u0026ndash;e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKornej J, B\u0026ouml;rschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century. Circul Res. 2020;127(1):4\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoriani G. The Epidemiologic Threat of Atrial Fibrillation: Need for Secondary, Primary, and Primordial Prevention. Chest. 2015;147(1):9\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCompiet SAM, Willemsen RTA, Konings KTS, Stoffers H. Competence of general practitioners in requesting and interpreting ECGs - a case vignette study. Neth Heart J. 2018;26(7\u0026ndash;8):377\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSomsen GA. The role of ECG screening in primary care; a call for collaboration between general practitioner and cardiologist. Neth Heart J. 2020;28(4):190\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Frequency distribution of the final diagnoses by cardiologist assessment of current ECGs and past history of AF in the electronic health records.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64.3678%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinal diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.555%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64.3678%;\"\u003e\n \u003cp\u003eNo abnormal ECG findings (including AF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e57.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.555%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64.3678%;\"\u003e\n \u003cp\u003eNewly diagnosed (current ECG)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.555%;\"\u003e\n \u003cp\u003e0.3-3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64.3678%;\"\u003e\n \u003cp\u003ePast history of AF confirmed by current ECG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.555%;\"\u003e\n \u003cp\u003e0.02-0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64.3678%;\"\u003e\n \u003cp\u003ePast history of AF with negative current ECG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.555%;\"\u003e\n \u003cp\u003e0.4-3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64.3678%;\"\u003e\n \u003cp\u003ePast history of AF presenting with other ECG findings apart of AF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.555%;\"\u003e\n \u003cp\u003e0.3-3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64.3678%;\"\u003e\n \u003cp\u003eOther positive ECG findings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e36.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.555%;\"\u003e\n \u003cp\u003e30.2-42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64.3678%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8.53859%;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18.555%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e: ECG findings of the family medicine physician compared with those of a cardiologist.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003efamily physician ECG findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 425px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiologist ECG review\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther positive findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eAF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eOther positive findings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAF diagnosis by the family physician is associated with the following test performance characteristics:\u003c/p\u003e\n\u003cp\u003eSensitivity=71.4%\u003c/p\u003e\n\u003cp\u003eSpecificity=99.2%\u003c/p\u003e\n\u003cp\u003ePPV=71.4%\u003c/p\u003e\n\u003cp\u003eNPV=99.2%\u003c/p\u003e\n\u003cp\u003ePretest probability=2.8%\u003c/p\u003e\n\u003cp\u003eAccuracy = 98.1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e: The prevalence rates of selected risk factors.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 307px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive risk factors for AF (N=249)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 307px;\"\u003e\n \u003cp\u003eHigh Blood Pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e62.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e56.6-68.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 307px;\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e57.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e50.9-63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 307px;\"\u003e\n \u003cp\u003eFemale sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e45.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e38.8-51.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 307px;\"\u003e\n \u003cp\u003eAge 75+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e28.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22.9-34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 307px;\"\u003e\n \u003cp\u003eVascular Disease (Angina, myocardial infarction)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5.6-12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 307px;\"\u003e\n \u003cp\u003ePrevious Stroke or Transient Ischemic Attack (TIA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.8-8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 307px;\"\u003e\n \u003cp\u003eCongestive Heart Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.4-3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e: Risk of having AF according to selected risk factors.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfirmed Atrial Fibrillation (Cardiologist)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI (OR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCongestive Heart Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e(1.6 - 251.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.08[NS]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e97.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e(1.3 - 35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e65-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e98.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e75+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eVascular Disease (Angina, myocardial infarction)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e(0.8 - 23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.13[NS]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e97.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e91.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHigh Blood Pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e(0.4 - 31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.26[NS]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e98.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e96.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e(0.4 - 10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.48[NS]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e98.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e96.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePrevious Stroke or Transient Ischemic Attack (TIA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1[NS]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e97.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e7.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e1[NS]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e(0.2 - 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e97.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Atrial Fibrillation, Screening, Primary Care, Older Adults, Stroke Prevention, Qatar, Public Health","lastPublishedDoi":"10.21203/rs.3.rs-5778095/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5778095/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAtrial fibrillation (AF) is the most common arrhythmia in clinical practice, and its prevalence is increasing in aging populations. It is a leading cause of acute stroke, heart failure, sudden death, and other cardiovascular morbidities. AF is often asymptomatic and is frequently diagnosed late, typically after a patient presents with acute stroke. Early detection and treatment can prevent such life-threatening events, making AF screening a public health priority. However, diagnosing asymptomatic AF remains challenging. While international guidelines recommend AF screening, Qatar lacks documented prevalence data and formal screening programs. This study aimed to assess the feasibility of an AF screening program for older adults in Qatar.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted among individuals aged ≥65 years registered with the Primary Health Care Corporation (PHCC)-Qatar, which serves approximately 70% of Qatar’s population. A simple random sample of 139 to 385 individuals was determined to ensure a sampling error of 5% to 3%, assuming a 10% AF prevalence. The participants underwent screening via standard ECG tracing that were reviewed independently by both the family physicians and a cardiologist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of AF among the study population was 5.4%. Newly diagnosed cases accounted for 2% of the 249 participants screened. All newly detected patients had a CHA2DS2VASc scores indicating the need for anticoagulant therapy to reduce stroke risk. Furthermore, compared with cardiologists, the family physicians in primary care successfully identified 75% of AF cases through ECG.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIf implemented nationally among individuals aged ≥65 years, the screening program could identify 747 undiagnosed AF cases among the 37,371. AF screening for individuals aged ≥75 years appears to offer a favorable cost‒benefit ratio, supporting the implementation of a targeted screening strategy in Qatar.\u003c/p\u003e","manuscriptTitle":"Screening for Atrial Fibrillation in Older Adults in Primary Care: A Cross-Sectional Pilot Study in Qatar","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-23 06:57:27","doi":"10.21203/rs.3.rs-5778095/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b50b83d-58a7-47af-b59d-0b7e98ca8287","owner":[],"postedDate":"January 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-31T16:53:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-23 06:57:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5778095","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5778095","identity":"rs-5778095","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}