Screening Seniors Improves Atrial Fibrillation Detection, A Major Risk Factor For Stroke

According to an article published in the British Medical Journal (BMJ), actively screening elderly people in the community improves detection of atrial fibrillation, which is a major risk factor for stroke. Atrial fibrillation is the chaotic beating of the top chambers (atria) of the heart which can cause a rapid irregular pulse.


About 1% of the general population suffers from atrial fibrillation. However, the prevalence leaps to 5% among the over 65s. An electrocardiography can diagnose it rapidly and at fairly low cost. By treating more atrial fibrillation patients earlier, as a result of screening, it would be possible to cut the number of stroke cases significantly.


There are two ways to screen for atrial fibrillation - Opportunistic and Systematic screening


-- Opportunistic screening means a health care professional (HCP) would check the patient's heartbeat (take his/her pulse) during an unrelated consultation. If anything irregular were detected, an electrocardiography would follow.


-- Systematic screening means targeting a whole population, inviting people for screening by electrocardiography.


In this study the researchers wanted to find out whether Systematic Screening was more effective in detecting atrial fibrillation in the community than Opportunistic Screening.


14,802 patients were identified. They were all aged 65 or more, and were selected from 50 general practices throughout England. These were then divided into 25 intervention and 25 control practices.


In the intervention practices patients were randomly allocated to systematic screening and opportunistic screening. Screening happened over 12 months in each practice, spanning the period October 2001 to February 2003.


Screening practices detected significantly more atrial fibrillation cases than the control practices. Opportunistic and Systematic screenings detected more or less the same number of new cases. Both processes were acceptable to patients and did not raise their anxiety.


The authors say that routine electrocardiography within this population group is not necessary for the detection of atrial fibrillation, as long as the patients' pulse is always taken during a routine or unrelated visit.


Systematic screening cannot be justified for detection of atrial fibrillation, concluded the authors. It is more labor intensive and costly and does not have a better detection rate than opportunistic screening.


Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial

David A Fitzmaurice, F D Richard Hobbs, Sue Jowett, Jonathon Mant, Ellen T Murray, Roger Holder, J P Raftery, S Bryan, Michael Davies, Gregory Y H Lip, T F Allan

BMJ, doi:10.1136/bmj.39280.660567.55

Click here to view abstract online