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
INTRODUCTION: Calcified chronic subdural hematoma which is usually found in children and takes several months for calcification to be seen on imaging is presented in an elderly patient in which the calcification could be visible early after trauma. PRESENTATION OF CASE: An elderly man, 83, living with caregiver, was brought to our hospital due to dysarthria and suffocation for 2 days. Three months ago, he experienced his head injury from a fall. Four days ago, he developed progressive left hemiparesis. Because of clinically progressive deterioration and computed tomography scan revealing acute epidural hematoma, the patient was transferred to operating room. Gross findings and pathologic reports unfolded that the lesion was consistent with calcified chronic subdural hematoma. Despite a successful operation, the patient cannot survive. DISCUSSION: In addition to the presentation in an elderly patient, there was scarcely any paper reporting an early presentation of calcium deposition. Nevertheless, according to the lack of previous data recorded for his earlier performance, deviation on walking or sitting, before the accident, we cannot actually know whether there has been calcium deposition in his brain before or not. CONCLUSION: Calcified chronic subdural hematoma could present in elderly group of patient and early presentation of calcium deposition following trauma is possible. However, surgery in this group of patient entails a risk of fatality, despite the successful operation.