Point-of-Care Atrial Fibrillation Screening Using Mobile Electrocardiography in a CKD Patient Population

Background: Recent metadata analysis suggests chronic kidney disease (CKD) patients have an increased incidence of atrial fibrillation (AF). Mobile electrocardiograms (ECGs) provide a low-cost, scalable technology for simple and efficient AF screening. In this study, we aim to use the KardiaMobile (AliveCor), a single-lead mobileECG, to examine the detection of subclinical AF amongst CKD patients in an outpatient nephrology setting. Methods: From October 2020 to April 2024, 353 University of Florida Shands Nephrology patients filled out an informed consent form and one-page survey regarding heart and kidney health. A 30-second ECG rhythm strip was obtained by a trained research assistant using the Kardia Mobile ECG. The subsequent ECG reading provided by the device, along with the survey results were: flagged for abnormalities, applied to a CHA2DS2-VASc score to stratify the risk of stroke, and assessed by an electrophysiologist ordering a 12-lead ECG to confirm previously undetected AF in CKD Stage III-IV patients. Results: The ECG readings determined 281 (79.6%) of patients had a normal single-lead rhythm strip, 72 (20.4%) had an irregular strip with possible arrhythmia indication of which 51 (14.4%) patients were confirmed to have AF. Of the previous undetected AF in CKD patient population the average CHA2DS2-VASc score was 3.2, indicating an elevated risk for stroke and oral anticoagulant therapy being recommended regardless of sex. The sample population was 51.03% female and 48.46% male with 0.51% of patients not answering. The mean age of participants was 65.25 with a standard deviation of 13.69. Conclusion: The KardiaMobile device allowed for a primary screening tool to be applied in an outpatient clinic setting enabling CKD patients to gain insight about cardiovascular health through a 30-second single lead rhythm strip. Early detection and appropriate medical management of AF reduces risk of stroke, providing the nephrologist valuable information to optimize patient care. Further testing in larger, more diverse patient populations could help establish more direct connections between kidney disease and AF.