Abstract
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.
Highlights
Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial depolarizations and disrupted atrial function [1,2]
We attempted from a routine daily clinical practice to conduct a real life examination of the European Society of Cardiology (ESC) and the Danish Society of Cardiology guidelines recommendations adopting opportunistic screening of irregular pulse in a primary care setting to detect new AF patients
The results found in terms of cases of irregular pulse as well as those with indication of AF were in line with the previous finding by opportunistic screening in Fitzmaurice et al [12]
Summary
Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial depolarizations and disrupted atrial function [1,2]. In the developed world the prevalence is approximately 1.5– 2% of the general population with more than 6 million people in Europe and 5 million people in the United States currently suffering from AF [1,2,7]. Projections suggest these figures to at least double in Europe and USA by 2050 due to an aging population [1,2,8]. Detection and diagnosing of AF can be made by several, including general practitioners (GP’s), specialists or by health care professionals during inpatient stay at the hospital
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