Sears, Samuel F.Kropp, Caley M2020-02-042021-12-012019-122019-12-12December 2http://hdl.handle.net/10342/7618Background: Eastern North Carolina has historically high prevalence rates of cardiovascular disease. Novel solutions such as mobile screening technology may aid in reaching this region’s vulnerable health population to prevent further disease progression. Additionally, symptoms of psychological distress are commonly comorbid with cardiovascular disease but often overlooked as formal predictors or modifiers of increased disease burden. Behavioral medicine providers recognize the importance of screening for psychological stress as it relates to cardiovascular disease as a way to reduce disease burden and advancement. Therefore, mobile-ECG screening for atrial fibrillation and exploration of adding psychological variables to a well-established cardiovascular stroke risk calculator (CHA₂DS₂-VASc) are discussed. Methods: Participants (N = 250) were approached at pharmacies in Eastern North Carolina. Participants completed demographic and medical history questionnaires, the DASS-21, and were administered a single-lead mobile-ECG (mECG). All mECG readings were interpreted by the mECG device in addition to adjudication by three electrophysiologists. Medical referrals were provided when indicated. Chi-squared statistics were utilized to investigate regional rates of atrial fibrillation and associated risk factors. Binary logistic regression modeling measured the capability of the CHA₂DS₂-VASc stroke risk calculator to predict abnormal mECG readings both with and without the addition of DASS-21 symptom scores. Results: Rates of previously undiagnosed atrial fibrillation were much higher than rates found in studies of similar scope and design. Participants’ average CHA₂DS₂-VASc scores (2.68 ± 1.35) signify an alarming rate of untreated ischemic stroke risk in a community sample. Additionally, the prevalence rates of six, known independent stroke risk factors were also significantly higher in the study sample than reported national US averages. Significant correlations were not found between psychological endpoints and abnormal mECG readings or elevated CHA₂DS₂-VASc scores, but binary logistic regression modeling revealed that a longstanding stroke risk calculator could be potentially strengthened with the addition of one (anxiety) or three (depression, anxiety, and stress) psychological endpoints. Discussion: The results of the current study further the knowledge of the utility of using mobile-health techniques to capture previously undiagnosed atrial fibrillation and associated risk factors. Prevalence of chronic disease and other health metrics in the Eastern North Carolina region are substantially worse than the general US population. Additionally, the results presented begin a compelling argument for the addition of psychological symptom scores to a long-standing stroke risk calculator.application/pdfenCardiac PsychologyHealth PsychologyMobile HealthECGCommunity ScreeningAtrial fibrillation--North Carolina--TestingCardiovascular system--Diseases--Patients--North Carolina--PsychologyWireless communication systems in medical care--North CarolinaDoctoral Dissertation2020-01-29