Systematic Model-based Approach to Risk-based Targeting, SMART-India (Atrial Fibrillation Screening)
PI: Dr. Apurv Soni
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.
Aim:
To screen adults in villages using pocket-sized ECG devices.
Impact:
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Brought digital screening into rural public health.
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Prevalence matched rates seen in high-income countries, suggesting under detection rather than truly lower incidence.
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Demonstrated feasibility of mobile ECG screening by community health workers.
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Supported serial checks to detect intermittent atrial fibrillation in low-resource settings.
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2100 enrolled participants, 2074 iECGs collected, 1947 questionnaires completed, and 33 AF cases identified.
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Village health workers performed three handheld iECG recordings per participant over five days, with expert adjudication of “possible AF” traces.
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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).