A Campaign for Information and Diagnosis of Atrial Fibrillation: “Pulse Week”

Sanmartín, Marcelo; Fraga, Francisco Fraguela; Martín-Santos, Ángel; Blázquez, Pilar Moix; García-Ruiz, Alba; Vázquez-Caamaño, María; Vilar, Manuel

doi:10.1016/j.rec.2012.05.009

Cited by 18 publications

(19 citation statements)

References 14 publications

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“…This is reflected in the results, with a much higher proportion of newly diagnosed AF cases having a previous history of MI than screen-detected or asymptomatic AF cases. The proportion of patients with a previous MI was 5.4% 135 and 0% 138 in the two studies of screen-detected AF. We pooled the data from both studies reporting results for screen-detected AF using a fixed-effects meta-analysis for use in our model.…”

Section: Methods For the Economic Evaluation Of Atrial Fibrillation Smentioning

confidence: 87%

“…We pooled the data from all seven studies (eight arms) reporting results for screen-detected AF using a random-effects meta-analysis to account for heterogeneity, reported in Table 35. However, the most relevant study to a UK screening population is the SAFE study, 153 the estimate for which is only just 135 and Sanmartin 138 were pooled using a fixed-effects meta-analysis (insufficient number of studies to estimate a random-effects model) on a log odds scale in WinBUGS version 1.4.3 (convergence checked using the Brooks-Rubin-Gelman diagnostic, n = 10,000 burn-in, n = 20,000 sample). Results converted to probabilities for presentation.…”

Section: Methods For the Economic Evaluation Of Atrial Fibrillation Smentioning

confidence: 99%

“…Both of these studies detected a higher proportion of paroxysmal AF than persistent or permanent AF, suggesting that paroxysmal AF is more prevalent in people with undiagnosed AF, but that most screening studies are not able to detect it. For example, among the new AF cases detected by Sanmartín et al, 138 only 6% were paroxysmal AF. In our model we assumed that 6% of screen-detected AF is paroxysmal AF and the remaining 94% is permanent or persistent AF.…”

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confidence: 92%

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Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

122

116

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BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources.ObjectivesTo conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model.DesignSystematic review, meta-analysis and cost-effectiveness analysis.SettingPrimary care.ParticipantsAdults.InterventionScreening strategies, defined by screening test, age at initial and final screens, screening interval and format of screening {systematic opportunistic screening [individuals offered screening if they consult with their general practitioner (GP)] or systematic population screening (when all eligible individuals are invited to screening)}.Main outcome measuresSensitivity, specificity and diagnostic odds ratios; the odds ratio of detecting new AF cases compared with no screening; and the mean incremental net benefit compared with no screening.Review methodsTwo reviewers screened the search results, extracted data and assessed the risk of bias. A DTA meta-analysis was perfomed, and a decision tree and Markov model was used to evaluate the cost-effectiveness of the screening strategies.ResultsDiagnostic test accuracy depended on the screening test and how it was interpreted. In general, the screening tests identified in our review had high sensitivity (> 0.9). Systematic population and systematic opportunistic screening strategies were found to be similarly effective, with an estimated 170 individuals needed to be screened to detect one additional AF case compared with no screening. Systematic opportunistic screening was more likely to be cost-effective than systematic population screening, as long as the uptake of opportunistic screening observed in randomised controlled trials translates to practice. Modified blood pressure monitors, photoplethysmography or nurse pulse palpation were more likely to be cost-effective than other screening tests. A screening strategy with an initial screening age of 65 years and repeated screens every 5 years until age 80 years was likely to be cost-effective, provided that compliance with treatment does not decline with increasing age.ConclusionsA national screening programme for AF is likely to represent a cost-effective use of resources. Systematic opportunistic screening is more likely to be cost-effective than systematic population screening. Nurse pulse palpation or modified blood pressure monitors would be appropriate screening tests, with confirmation by diagnostic 12-lead electrocardiography interpreted by a trained GP, with referral to a specialist in the case of an unclear diagnosis. Implementation strategies to operationalise uptake of systematic opportunistic screening in primary care should accompany any screening recommendations.LimitationsMany inputs for the economic model relied on a single trial [the Screening for Atrial Fibrillation in the Elderly (SAFE) study] and DTA results were based on a few studies at high risk of bias/of low applicability.Future workComparative studies measuring long-term outcomes of screening strategies and DTA studies for new, emerging technologies and to replicate the results for photoplethysmography and GP interpretation of 12-lead electrocardiography in a screening population.Study registrationThis study is registered as PROSPERO CRD42014013739.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Methods For the Economic Evaluation Of Atrial Fibrillation Smentioning

confidence: 87%

Section: Methods For the Economic Evaluation Of Atrial Fibrillation Smentioning

confidence: 99%

mentioning

confidence: 92%

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Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

122

116

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show abstract

“…Stroke was also not an exclusion criterion. Other smaller AF screening studies have focused on select populations with prior stroke or transient ischemic attack, rather than general populations . Among these studies, prevalence of new paroxysmal AF has ranged from 5% to 20%, with detection rates typically increasing with greater follow‐up time .…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Extended Ambulatory Electrocardiogram Monitoring to Identify Silent Atrial Fibrillation in High‐risk Patients: The Screening Study for Undiagnosed Atrial Fibrillation (STUDY‐AF)

Turakhia

Ullal

Hoang

et al. 2015

Clinical Cardiology

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BackgroundIdentification of silent atrial fibrillation (AF) could prevent stroke and other sequelae.HypothesisScreening for AF using continuous ambulatory electrocardiographic (ECG) monitoring can detect silent AF in asymptomatic in patients with known risk factors.MethodsWe performed a single-center prospective screening study using a wearable patch-based device that provides up to 2 weeks of continuous ambulatory ECG monitoring (iRhythm Technologies, Inc.). Inclusion criteria were age ≥55 years and ≥2 of the following risk factors: coronary disease, heart failure, hypertension, diabetes, sleep apnea. We excluded patients with prior AF, stroke, transient ischemic attack, implantable pacemaker or defibrillator, or with palpitations or syncope in the prior year.ResultsOut of 75 subjects (all male, age 69 ± 8.0 years; ejection fraction 57% ± 8.7%), AF was detected in 4 subjects (5.3%; AF burden 28% ± 48%). Atrial tachycardia (AT) was present in 67% (≥4 beats), 44% (≥8 beats), and 6.7% (≥60 seconds) of subjects. The combined diagnostic yield of sustained AT/AF was 11%. In subjects without sustained AT/AF, 11 (16%) had ≥30 supraventricular ectopic complexes per hour.ConclusionsOutpatient extended ECG screening for asymptomatic AF is feasible, with AF identified in 1 in 20 subjects and sustained AT/AF identified in 1 in 9 subjects, respectively. We also found a high prevalence of asymptomatic AT and frequent supraventricular ectopic complexes, which may be relevant to development of AF or stroke. If confirmed in a larger study, primary screening for AF could have a significant impact on public health.

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“…Саме рутинний контроль пульсу визнано основним засобом первинної діагностики БФП у європейських рекомендаціях [57]. Оцінювання пульсу упродовж тижня у 1532 осіб без анамнестичних даних про ФП дозволило у 17 пацієнтів за підозрити БФП, яка в подальшому була зареєстрована на ЕКГ [86]. У масштабному аналізі клінічних да них пацієнтів із зафіксованими пароксизмами БФП після успішної медикаментозної кардіоверсії як основні методи контролю ритму використовувалися рутинна реєстрація ЕКГ (31,3 %) та добове моніторування ЕКГ (34,4 %).…”

Section: сучасні методи діагностики безсимптомної фібриляції передсердьunclassified

Diagnosis and prognostic value of asymptomatic atrial fibrillation

Pavlyk¹,

Chernyaha-Royko²,

Sorokivskyy³

et al. 2019

CSIC

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Львівський обласний державний клінічний лікувально-діагностичний кардіологічний центр 2 Львівський національний медичний університет імені Данила Галицького 3 Національна медична академія післядипломної освіти імені П.Л. Шупика, Київ

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A Campaign for Information and Diagnosis of Atrial Fibrillation: “Pulse Week”

Cited by 18 publications

References 14 publications

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Feasibility of Extended Ambulatory Electrocardiogram Monitoring to Identify Silent Atrial Fibrillation in High‐risk Patients: The Screening Study for Undiagnosed Atrial Fibrillation (STUDY‐AF)

Diagnosis and prognostic value of asymptomatic atrial fibrillation

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