Key result
Opportunistic screening in primary care detects new AF in ~1% of patients over 65.
Why the study?
Does nurse-assisted opportunistic screening using pulse palpation and targeted ECG detect new cases of atrial fibrillation in patients ≥65 years of age in primary care?
Cross-Sectional (n=970)
Open-label
Cluster randomization at clinic level
Yes
Does nurse-assisted opportunistic screening using pulse palpation and targeted ECG detect new cases of atrial fibrillation in patients ≥65 years of age in primary care?
Opportunistic screening for atrial fibrillation in primary care using pulse palpation and targeted ECG is feasible and successfully identifies new cases, particularly in patients aged 85 and older.
Opportunistic AF screening appears feasible in primary care; leaves open whether implementation improves outcomes without randomized trials.
Atrial fibrillation (AF) is a chronic disease with an incidence increasing steeply by age and affecting more than 11 million patients in Europe and the United States. Diagnosing AF is essential for the prevention of stroke by oral anticoagulation. Opportunistic screening for AF in patients ≥65 years of age is recommended by the European and Danish Societies of Cardiology. The study aim was to examine the detection rate of AF in consecutively screened patients in the primary care setting in Denmark. In an open, non-interventional, cluster, multicenter, cross-sectional, observational study patients ≥65 years of age entering consecutively into general practice clinics were invited to nurse-assisted opportunistic screening for AF. The General Practice (GP) clinics participating were randomized to patient inclusion in three age groups: 65-74, 75-84, and ≥85 years respectively. All patients underwent pulse palpation followed by 12-led electrocardiogram in case of irregular pulse. Two cardiologists validated all electrocardiogram examinations. Forty-nine general practice clinics recruited in total 970 patients split into three age groups; 480 patients (65-74 years), 372 (75-84 years), and 118 patients ≥85 years of age. Co-morbidities increased by age with hypertension being most frequent. Eighty-seven patients (9%) were detected with an irregular pulse, representing 4.4%, 10.5% and 22.9%, respectively in the three age groups. Assessment of electrocardiograms by the GP showed suspicion of AF in 13 patients with final verification of electrocardiograms by cardiologists revealing 10 AF-patients. The highest detection rate of AF was found in the ≥85 age group (3.39%) followed by the 65-74 age group (0.83%) and the 75-84 age group (0.54%). Opportunistic screening of AF in primary care is feasible and do result in the detection of new AF-patients. Close collaboration with cardiologists is advisable to avoid false positive screening results.
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Hald et al. (2017) conducted a cross-sectional in Atrial fibrillation (n=970). Opportunistic screening for atrial fibrillation (pulse palpation and ECG) was evaluated on Percentage of newly detected AF-patients (95% CI 0.40-1.67). Opportunistic screening for atrial fibrillation in primary care detected new cases in 1.03% of patients aged 65 and older, with the highest detection rate of 3.39% in patients aged 85 and older.
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