1. An opportunistic screening protocol for atrial fibrillation was not found to improve diagnostic rates, compared to usual care.
Evidence Rating Level: 1 (Excellent)
Atrial fibrillation (AF) is a cardiac arrhythmia that increases in prevalence with age. AF can also lead to cardiovascular conditions such as stroke and heart failure. Although the symptoms are well-known, such as shortness of breath, palpitations, and dizziness, AF can also appear asymptomatic at times, or occur as unpredictable flare-ups. This underlies the importance of effective AF screening and early detection. Still, only 1 other randomized controlled trial was conducted on the effects of AF screening and diagnosis, showing that opportunistic screening led to more diagnoses than usual care. However, this study was done in 2007, and technological advances in screening have been made since then, such as handheld electrocardiographic devices. The current study was a 1-year randomized controlled trial in the Netherlands, comparing AF diagnoses with opportunistic screening versus usual care. The study population included 17,976 patients aged 65 and over, from 96 primary care practices in the country; each practice was randomized into one of the two groups, stratified by the existing number of AF patients in the practice. The opportunistic group screened any primary care patient with one or more positive index tests (pulse palpation, electronic blood pressure monitor, or hand electrocardiograph), as well as randomly screening patients with negative results for all 3 tests. In the study, 45% of eligible patients were screened through the opportunistic protocol. Usual care may have differed for each physician in the study, but national guidelines suggested assessing heart rhythm in any patient presenting with AF symptoms. The study found that 1.62% of patients in the opportunistic group were newly diagnosed with AF, compared to 1.53% of patients in the usual care group. This was not a significant difference (Odds Ratio 1.06, 95% CI 0.84-1.35, P = 0.60). Therefore, an opportunistic screening protocol did not impact AF diagnostic rates, which highlights the need for exploring other methods to diagnose patients early, such as through targeted screening or heart rhythm monitoring through common wireless devices.
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