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Screening of older patients for atrial fibrillation in general practice: Current evidence and its implications for
Matthew R Fay1, David A Fitzmaurice2, Ben Freedman3
1a Westcliffe Practice Group and Westcliffe Cardiology Service , Shipley , West Yorkshire , UK.
Insights
Screening for atrial fibrillation (AF) can identify asymptomatic cases, reducing stroke risk. Early detection through pulse checks or handheld devices in primary care is key for effective anticoagulant treatment and stroke prevention.
Area of Science:
- Cardiology
- Public Health
- Geriatrics
Background:
- Individuals with atrial fibrillation (AF) have a fivefold higher risk of ischemic stroke.
- Asymptomatic AF increases stroke risk but often goes undiagnosed until a stroke occurs.
- Early identification of undiagnosed AF is crucial for initiating anticoagulant therapy.
Purpose of the Study:
- To review screening strategies for atrial fibrillation in primary care.
- To evaluate the benefits and limitations of various screening methods and devices.
Main Methods:
- Narrative review of proposed screening strategies.
- Consideration of single and multiple time-point screening.
- Assessment of devices for primary care implementation.
Main Results:
- Opportunistic pulse palpation followed by ECG is cost-effective for detecting asymptomatic AF.
- Handheld devices can facilitate screening in primary care for high-risk groups (e.g., age ≥65, hypertension).
Conclusions:
- Improved AF detection and diagnosis are vital for stroke prevention.
- Appropriate anticoagulation strategies are essential for reducing stroke incidence.
- Effective AF screening can lower the social and economic costs associated with stroke.
Background:
Individuals with atrial fibrillation (AF) face a fivefold increased risk of ischaemic stroke compared with those without the condition. Recent studies suggest that individuals with asymptomatic AF also face an increased risk of ischaemic stroke, but their condition is often not recognized and diagnosed until an ischaemic stroke event has occurred. Identification of individuals with undiagnosed AF at increased risk for stroke is critical in promoting optimal intervention with anticoagulants.
Objectives:
In this narrative review, we consider the benefits and limitations of various proposed screening strategies, whether single or multiple time-points, in addition to devices for implementation in the primary care setting.
Outcomes:
Opportunistic screening via pulse palpation with subsequent referral for 12-lead electrocardiogram testing has been shown to cost-effectively identify individuals with asymptomatic AF. Some handheld devices suitable for use in primary care settings are now available and may facilitate screening of large cohorts of individuals considered to be at increased risk of AF, such as those aged ≥65 years or those diagnosed with or undergoing monitoring for hypertension.
Conclusions:
It was determined that improved detection and diagnosis of AF, combined with appropriate anticoagulation strategies, will be crucial for improving stroke prevention and reducing its associated social and economic costs.