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Systematic Model-based Approach to Risk-based Targeting, SMART-India (Atrial Fibrillation Screening)

PI USA: Dr. Apurv Soni, Dr. David McManus.

PI India: Dr. Somashekhar Nimbalkar, Dr.Sunil Karna

Trainee: Dr.Sunil Thanvi

Objective:
To detect undiagnosed atrial fibrillation (Afib) using mobile ECG tools. This community-based screening initiative assessed undiagnosed atrial fibrillation in rural Gujarat—first through a pilot with 234 adults aged ≥50 years using serial single-lead ECGs, and then in a population-based study involving 2,074 adults aged ≥40 years across 50 villages.

Background:
Afib increases stroke risk but often goes undiagnosed, especially in rural communities.

Outcomes:

  • Brought digital screening into rural public health.

  • Prevalence matched rates seen in high-income countries, suggesting under detection rather than truly lower incidence.

  • Demonstrated feasibility of mobile ECG screening by community health workers.

  • Supported serial checks to detect intermittent atrial fibrillation in low-resource settings.

  • 2100 enrolled participants, 2074 iECGs collected, 1947 questionnaires completed, and 33 AF cases identified.

  • Village health workers performed three handheld iECG recordings per participant over five days, with expert adjudication of “possible AF” traces.

  • Overall AF prevalence was 1.6%, rising sharply with age (0.6% at 40–55 to 5.6% at >75) and higher in men (2.3% vs. 1.0%; p=0.03).

Publications

  • Soni A, Earon A, Handorf A, et al. High Burden of Unrecognized Atrial Fibrillation in Rural India: An Innovative Community-Based Cross-Sectional Screening Program. JMIR Public Health Surveill. 2016;2:e159. doi:10.2196/publichealth.6517.

  • Soni A, Karna S, Fahey N, et al. Age-and-sex stratified prevalence of atrial fibrillation in rural Western India: Results of SMART-India, a population-based screening study. Int J Cardiol. 2019;280:84–8.

  • Soni A, Karna S, Patel H, et al. Study Protocol for Smartphone Monitoring for Atrial fibrillation in Real-Time - India (SMART-India). BMJ Open. 2017;7:e017668.