Abstract
BackgroundAtrial fibrillation (AF) is often asymptomatic and undiagnosed until an ischaemic stroke occurs. An irregular pulse is a key manifestation of AF. We assessed whether pulse self-palpation is feasible in screening of AF.MethodsAltogether 205 residents of Lieto municipality aged ≥75 years were randomized in 2012 to receive brief education on pulse palpation focusing on evaluating rhythm regularity. Self-detected pulse irregularity and new AF diagnoses were recorded, and the subjects’ quality of life and use of health care services were assessed during a three-year follow-up.ResultsThe subjects’ median age was 78.2 [3.8] years, and 89 (43.4%) were men. Overall, 139 (68%) subjects had initial good motivation/capability for regular palpation. At four months, 112 (80.6%) subjects with good and 26 (39.4%) with inadequate motivation/capability palpated their pulse daily. At 12 months, 120 (58.5%) and at 36 months, 69 (33.7%) subjects palpated their pulse at least weekly. During the intervention, 67 (32.7%) subjects reported pulse irregularity. New AF was found in 10 (4.9%) subjects, 7 (70%) of whom had reported pulse irregularity. Pulse irregularity independently predicted new AF, but only one (0.5%) subject with new AF sought undelayed medical attention due to pulse irregularity. Quality of life and number of outpatient clinic visits remained unchanged during follow-up.ConclusionPulse palpation can be learned also by the elderly, but it is challenging to form a continuing habit. The low persistence of pulse self-palpation limits its value in the screening of AF, and strategies to promote persistence and research on alternative screening methods are needed.Trial registrationhttp://www.ClinicalTrials.gov identifier: NCT01721005. The trial was registered retrospectively on October 26, 2012.
Highlights
Atrial fibrillation (AF) is often asymptomatic and undiagnosed until an ischaemic stroke occurs
We report the persistence of the habit of regular pulse palpation and the yield of the intervention and its effect on quality of life during a follow-up of three years
High Mini-Mental State Examination (MMSE) Score, computer use at home, independence at daily activities and low heart rate were the independent predictors of learning pulse palpation and being motivated to continue the self-detection of heart beat at a one-month follow-up as described previously [14]
Summary
Atrial fibrillation (AF) is often asymptomatic and undiagnosed until an ischaemic stroke occurs. Atrial fibrillation (AF) is a major risk factor of thromboembolism and ischaemic stroke [1], and its prevalence in ischaemic stroke patients is 15–25% [2, 3]. Paroxysmal, asymptomatic AF is probably the underlying aetiology in a significant share of cryptogenic strokes: two recent randomised controlled studies uncovered new Approximately 10–40% of AF is asymptomatic or ‘silent’ [10] and as a result ischaemic stroke is too often the first clinical manifestation of AF [11]. The 2012 focused update of the European Society of Cardiology guidelines on the management of AF recommends opportunistic pulse palpation in patients aged 65 years or older, followed by the recording of ECG for screening of AF [13]
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