Screening for atrial fibrillation by village doctors in rural areas of china: the jiangsu province rural community atrial fibrillation project

Abstract Background No study has systematically investigated the quality of long-term care delivered to the rural elderly with chronic diseases in China. Since atrial fibrillation (AF) is becoming an increasing burden on healthcare systems worldwide. Purpose We conducted an AF screening programme in rural elderly and evaluated healthcare efficiency led by the village doctors in China. Methods This cross-sectional study of the rural population aged ≥65 years was conducted from April to June 2019 in our towns of Jiangsu Province. AF was identified using 12-lead electrocardiography in the first-step (government-led health examination) and single-lead electrocardiography in the second-step (in-house AF screening). Questionnaire surveys were designed for the AF patients and their village doctors, respectively. Results Among the 31,342 registered subjects, 12,630 (40·3%) declined, 7,956 (25·3%) participated in the first-step and 10,756 (34·3%) in the second-step (Figure 1). The overall AF detection rate was 4·3% (810/18,712). Of the 810 patients with AF (mean age 76·1±5·9 years; 51·4% female), 51·5% had education level below primary school, 2·6% could use smartphone applications, and 8·1% lived with their children. Common risk factors were older age, men, hypertension, diabetes, prior stroke, vascular disease, and congestive heart failure. Among the 402 patients who were aware of AF, there were 367 were at high risk of stroke (CHA2DS2-VASc score ≥3 in women or ≥2 in men) and OAC was currently used in only 10·9% (40/367) of these (Figure 2). Only 17·6% (91/516) of patients with known hypertension had a resting blood pressure level <140/90 mmHg, and 6·0% (8/132) of patients with known diabetes had a fasting blood glucose level ≤6·1 mmol/L. Our questionnaire survey for village doctors showed that only 7·3% (9/122) reported having the knowledge or ability for providing integrated care AF management. Conclusions This screening project in rural villages identified AF in 4·3%, but AF management was suboptimal with low use of oral anticoagulation. The current village doctor-dominant rural healthcare system is far from delivering optimal standardized AF management for older patients in rural China. There is a urgent need to support these rural clinics and empower the village doctors in optimising the care of AF patients.The flow chart of this studyThe use of oral anticoagulation