Research Paper Volume 13, Issue 13 pp 17024—17037

Prevalence and predictors of subclinical atrial fibrillation in hospitalized older adults

Francesco Spannella1,2, , Federico Giulietti1,2, , Lorenzo Pimpini3, , Francesca Elena Lombardi1,2, , Serena Re1,2, , Paola Schiavi1,2, , Gina Dragano1, , Roberto Antonicelli3, , Riccardo Sarzani1,2, ,

  • 1 Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
  • 2 Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
  • 3 Cardiology Unit, IRCCS INRCA, Ancona, Italy

Received: March 5, 2021       Accepted: June 22, 2021       Published: July 1, 2021
How to Cite

Copyright: © 2021 Spannella et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Subclinical atrial fibrillation (SCAF) is associated with an increased risk of clinical AF, major cardiovascular events and death. Short-term evidence on SCAF in older populations is scarce, especially in the hospital setting. We performed a cross-sectional study on 60 multimorbid older consecutive patients (aged 80+) admitted to an Internal Medicine and Geriatrics Unit for acute medical diseases with no history of AF, in order to investigate prevalence and predictors of SCAF. Portable ECG monitoring was placed on admission and ECG recording lasted for 5 days. Mean age: 85.7±4.9 years. Female prevalence: 58.3%. High burden of comorbidities: 87.9%. All enrolled patients had CHA2DS2-VASc score ≥3. SCAF was detected in 16 patients (26.7%) and 11 patients (18.4%) had at least a SCAF episode lasting 6 minutes or longer. No clinical, laboratory and echocardiographic parameters predicted SCAF. Patients with ≥2004 supraventricular ectopic beats/24h (SVEBs/24h) had a 6-fold higher prevalence of SCAF than patients with <411 SVEBs/24h (p=0.038). Time to first SCAF episode was within 3 days of ECG recording in all enrolled patients. SCAF is highly prevalent in older adults hospitalized for acute diseases. This finding may affect clinical management and prognosis. Our study could foster larger multicenter studies in similar settings.


ABG: arterial blood gas; ADL: activities of daily living; AF: atrial fibrillation; APBs: atrial premature beats; BMI: body mass index; BSA: body surface area; COPD: chronic obstructive pulmonary disease; CV: cardiovascular; ECG: electrocardiogram; eGFR: estimated glomerular filtration rate; ESC: European Society of Cardiology; GIC: geriatric index of co-morbidity; HGB: hemoglobin; IAB: interatrial block; LAVI: left atrial volume index; LVEF: left ventricular ejection fraction; LVH: left ventricular hypertrophy; LVMI: left ventricular mass indexed; HF: heart failure; NT-proBNP: N-terminal pro-B-type natriuretic peptide; PAPs: systolic pulmonary artery pressure; SCAF: subclinical atrial fibrillation; SVEBs: supraventricular ectopic beats; TAPSE: tricuspid annular plane excursion; VEBs: ventricular ectopic beats; WBC: white blood cell count.