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Effectiveness of systematic screening for the detection of atrial fibrillation

Creator:

Moran, P.S., et al

Subject Keywords: Screening programme, Detection, Atrial fibrillation
Type: Article
Region: International (other)
Description:

Atrial fibrillation is a common cardiac arrhythmia that makes the heart beat rapidly and irregularly. This can occur for brief episodes or may be continuous. Symptoms of the disease include heart palpitations, chest pain, shortness of breath, light-headedness and fatigue. The condition is rare in those under 40 years but gets more common as people age. Not everyone with atrial fibrillation experiences symptoms so some people are unaware that they have it, while others may experience mild symptoms that they do not attribute to the disease. Atrial fibrillation hinders the efficient flow of blood through the heart, resulting in an increased risk of clot formation. If these clots leave the heart they can block the vessels supplying blood to the brain, causing a stroke. Treatment with anticoagulant medication is designed to prevent the formation of blood clots and can reduce the risk of stroke by over 60%.

For a screening programme for atrial fibrillation to be worthwhile it needs to increase the rate of detection as well as benefitting those who are detected with the problem through screening. The aim of this review was to examine the first part of this question, to find out if screening increases the number of new diagnoses of atrial fibrillation compared with normal practice where people are diagnosed when they consult a health professional with symptoms or risk factors that would lead to them being tested. It also examined the safety and rate of uptake of screening, as well as the costs involved.

The review identified one study that met the inclusion criteria. This examined systematic screening, where everyone over 65 years was offered an electrocardiogram (ECG) test, and opportunistic screening, where those over 65 years had their pulse taken when they visited their general practitioner (GP) for any reason and were offered an ECG if an irregular pulse was found. Both these screening programmes increased the rate of detection of new cases of atrial fibrillation compared to normal practice. Screening appeared to be more effective in men than women but no information was available about its effectiveness in different ethnic or socioeconomic groups. Since only one study was found, it was not possible to compare the effectiveness of screening in different settings. Uptake of screening was higher for systematic screening than for opportunistic screening, and within both interventions the uptake was higher for men and the 65 to 74 age group compared to people over 75 years. No safety issues or complications were reported. From the point of view of the health service provider, systematic screening was more costly than opportunistic screening. However, because all of the results are based on a single study, one needs to be cautious about applying them outside of the setting (UK primary care) and patient population (aged over 65 years) in which the study was carried out.

Date:

30/04/2013

Rights: © The Cochrane Collaboration
Suggested citation:

Moran, P.S., et al. (2013) Effectiveness of systematic screening for the detection of atrial fibrillation [Online]. Available from: http://publichealthwell.ie/node/479791 [Accessed: 17th September 2019].

  

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