Screening for atrial fibrillation in primary care

Abstract

Objective-To investigate a population of elderly people for atrial fibrillation and to determine how many of the cases identified might benefit from treatment with anticoagulants. Methods-From a practice of four primary care physicians, 1422 patients aged 65 years and over were identified, of whom 1207 (85% of the total population) underwent electrocardiographic screening to detect the presence of atrial fibrillation. Patients with the arrhythmia were further evaluated by echocardiography and interview, to stratify their risk of stroke based on echocardiographic and clinical risk factors, their perceived risk from anticoagulation, and their attitude towards this treatment. Their primary care physician was also interviewed to determine the factors influencing the prescription of anticoagulants. Results-The arrhythmia occurred in 65 patients (5.4% overall), its prevalence increasing markedly with age (2.3% in 65 to 69 years age group; 8.1% in those over 85). Warfarin was being prescribed to 21.4% of these patients, although the findings of the study indicate that a further 20% were eligible for this treatment. Symptoms suggestive of cardiac failure were common (32.1%) and coexisting pathology was often identified by cardiac ultrasound in these patients (left ventricular hypertrophy, 32.1%; impaired left ventricular contractility, 21.4%; left atrial dilatation, 80.4%; mitral annular calcification, 42.9%; mitral stenosis, 7.1%; mitral regurgitation, 48.2%; aortic stenosis, 8.9%). In all but one case, the decision to anticoagulate was based on the clinical rather than the echocardiographic findings. Conclusions-Individual risk-benefit assessment in elderly patients with atrial fibrillation suggests that almost half (41.4%) are eligible for full anticoagulation with warfarin, whereas presently only one fifth are receiving this treatment. The decision to anticoagulate can be made on clinical grounds in most cases. If these results are confirmed, a doubling of the current number of patients taking anticoagulants can be anticipated. (Heart 1998;79:50-55)

Prevalence of Atrial Fibrillation and Antithrombotic Prophylaxis in Emergency Department Patients

“…The 5.7% (95% CI, 5.3 to 6.0) prevalence of AF in the population of patients undergoing ECG testing (nϭ15 238) matches the upper range of the 4.7% to 6.0% prevalence reported for populations Ն65 years of age. 1,9,26 This finding is not unexpected because 80% of records reviewed identified patients Ն65 years of age, again reflecting the frequency of ED evaluation of cardiovascular and pulmonary complaints in the elderly.…”

Stepwise Screening of Atrial Fibrillation in a 75-Year-Old Population

“…17,34 In a large randomised UK study 17 in patients aged >65 years, primary care centers were randomized to systematic or opportunistic screening, which was compared with routine care. In patients invited to systematic screening, 53% registered ECG, and a new AF diagnosis was noted in 52/2357 (2%).…”

Atrial Fibrillation and the Hypercoagulable State: From Basic Science to Clinical Practice

“…Despite the obvious superiority of wafarin over aspirin, only one-fourth to one-third of the eligible patients land up on warfarin [58][59][60]. This is mostly due to the inconvenience of regular INR monitoring, and multiple drug and food interactions with warfarin, resulting in an increased risk of bleeding.…”

“…Choudhury Table 2. Efficacy and safety outcomes of the SPORTIF III and V trails: ximelagatran versus warfarin in nonvalvular atrial fibrillation [60,61].…”