ABSTRACT
BACKGROUND: In Thailand, almost one-quarter of strokes are related to atrial fibrillation (AF), and many could be prevented if AF were diagnosed and treated prior to the stroke. Therefore, we tested a novel strategy to screen large numbers of community residents using village health volunteers and primary care nurses. METHODS: Local primary care nurses and village health volunteers in Phetchaburi and Lopburi provinces, Thailand were trained to perform AF screening using a blood pressure device with AF algorithm (Microlife A200 AFib). 10% of residents aged ≥ 65 years were randomly selected for screening during home-visits. Participants with possible AF were given follow-up appointments for further testing, including 12-lead ECG and echocardiogram. RESULTS: Over two-months, 9.7% (13,864/143,478) of the target population were screened: mean age 73.2 ± 6.4 years, 32.4% male. The estimated AF prevalence (detected by Microlife A200 AFib) was 2.8% (95% CI, 2.6-3.1%) for age ≥ 65 years (i.e. 393/13,864 participants). Prevalence increased with age from 1.9% (65-69 years) to 5.0% (≥85 years) (p < 0.001). Only 58% (226/393) of participants with suspected AF attended the follow-up appointment (1-3 months after initial screen): mean CHA2DS2-VASc score 3.2 ± 1.2; 86.3% (195/226) had Class-1 oral anticoagulation recommendation, and 33% (75/226) had AF on 12-lead ECG. CONCLUSIONS: In Thailand, large-scale AF screening in the community is feasible using trained volunteer health workers, allowing screening of large numbers in a short time-period. Further investigation of this strategy is warranted, ensuring mechanisms to obtain a timely rhythm strip or 12-lead ECG locally, and a designated pathway to treatment.
ABSTRACT
OBJECTIVE: The authors assessed the effects of an enteric-coated Thai garlic extract tablet standardized for allicin-releasing potential on serum lipid levels in hypercholesterolemic subjects. SUBJECTS AND METHOD: The authors performed a randomized, double-blind, placebo-controlled trial in 136 hypercholesterolemic subjects (cholesterol concentrations > or = 5.2 mmol/L; mean age +/- SD: 47.0 +/- 6.6 yr). All subjects were given dietary advice to lower fat intake within 4 weeks and were advised to eat normally during the study period. The subjects were randomly assigned to receive an enteric-coated Thai garlic extract tablet once daily (standardized to 1.12% allicin or 5.6 mg/tablet), or placebo after the evening meal for 12 weeks. Seventy subjects (32.9% male; mean age +/- SD and BMI of 47.0 +/- 6.6 yr and 24.6 +/- 3.3 kg/m2) received the garlic extract treatment while 66 subjects (37.9% male, mean age +/- SD and BMI of 47.0 +/- 6.0 yr and 24.3 +/- 3.4 kg/m2) received placebo. RESULTS: There were no statistically significant changes in serum total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol after the 12-week treatment as analyzed on repeated measures by analysis of variance. In addition, no changes in plasma glucose, liver and renal functions were found. CONCLUSIONS: Treatment with an enteric garlic-coated Thai garlic extract and dietary advice did not produce any significant changes in lipid levels in subjects with hypercholesterolemia.
