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Atrial fibrillation: a comparison of methods to identify cases in general practice
S Somerville1, J Somerville, P Croft
1Primary Care Sciences Research Centre, Keele University School of Postgraduate Medicine, Stoke-on-Trent. simon@somerville22.freeserve.co.uk
Insights
Screening for atrial fibrillation (AF) using nurse-led pulse palpation, followed by electrocardiographs for suspicious cases, efficiently identifies new patients. This improves access to crucial antithrombotic treatment for stroke prevention.
Area of Science:
- Cardiology
- Primary Care Medicine
- Preventive Cardiology
Background:
- Atrial fibrillation (AF) is a significant, treatable risk factor for stroke.
- Effective community-based screening methods are needed to identify undiagnosed AF cases.
- Early detection allows for timely initiation of antithrombotic therapy to reduce stroke risk.
Purpose of the Study:
- To evaluate the efficiency of practice-based screening strategies for atrial fibrillation.
- To assess the impact of different screening methods on time and financial costs.
- To determine the optimal approach for detecting undiagnosed atrial fibrillation in primary care settings.
Main Methods:
- Utilized nurse-led pulse palpation as an initial screening tool.
- Employed 12-lead and bipolar electrocardiographs (ECGs) for diagnostic confirmation.
- Compared various combinations of pulse palpation and ECG interpretation by practice nurses.
Main Results:
- Nurse-led pulse palpation is an effective first step in screening for atrial fibrillation.
- 12-lead ECGs are recommended for patients with a pulse suggestive of AF.
- Trained practice nurses can effectively interpret ECG findings for AF detection.
Conclusions:
- A combined strategy of nurse pulse palpation followed by ECG confirmation offers an efficient method for practice-based AF screening.
- This approach can increase the identification of previously undiagnosed atrial fibrillation cases.
- Optimized screening protocols facilitate wider access to antithrombotic treatment and stroke prevention.
Abstract:
The importance of atrial fibrillation as a treatable risk factor for stroke is well established. Less is known about how to find previously unidentified cases within the community so that antithrombotic treatment can be offered to a wider group of at-risk patients. The aim of our study was to examine ways to improve the efficiency of practice-based screening for atrial fibrillation, including issues of time and financial cost. We used different combinations of pulse palpation and interpretation of 12-lead and bipolar electrocardiographs as carried out by practice nurses. The best strategy for the detection of atrial fibrillation in a practice population would appear to be to screen all eligible subjects by nurse pulse palpation, followed by 12-lead electrocardiograph readings in those who have a pulse suggestive of atrial fibrillation. The electrocardiograph interpretation can be undertaken effectively by a trained nurse.