Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial

doi:10.1136/bmj.39280.660567.55

BMJ 2007;335:383 (25 August), doi:10.1136/bmj.39280.660567.55 (published 2 August 2007)

Research

Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial

David A Fitzmaurice, professor of primary care¹, F D Richard Hobbs, professor, head of department¹, Sue Jowett, research fellow¹, Jonathon Mant, reader¹, Ellen T Murray, research fellow¹, Roger Holder, head of statistics¹, J P Raftery, professor of health technology assessment², S Bryan, professor of health economics³, Michael Davies, consultant cardiologist⁴, Gregory Y H Lip, professor of cardiovascular medicine⁵, T F Allan, senior lecturer⁶

¹ Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT, ² Wessex Institute for Health Research and Development, University of Southampton, ³ Health Economics Facility, University of Birmingham, ⁴ Selly Oak Hospital, Birmingham, ⁵ University Department of Medicine, City Hospital, Birmingham, ⁶ Health Care Research Unit, St Bartholomew's School of Nursing and Midwifery, City University, London

Correspondence to: F D R Hobbs f.d.r.hobbs{at}bham.ac.uk

Objectives To assess whether screening improves the detectionof atrial fibrillation (cluster randomisation) and to comparesystematic and opportunistic screening.

Design Multicentred cluster randomised controlled trial, withsubsidiary trial embedded within the intervention arm.

Setting 50 primary care centres in England, with further individualrandomisation of patients in the intervention practices.

Participants 14 802 patients aged 65 or over in 25 interventionand 25 control practices.

Interventions Patients in intervention practices were randomlyallocated to systematic screening (invitation for electrocardiography)or opportunistic screening (pulse taking and invitation forelectrocardiography if the pulse was irregular). Screening tookplace over 12 months in each practice from October 2001 to February2003. No active screening took place in control practices.

Main outcome measure Newly identified atrial fibrillation.

Results The detection rate of new cases of atrial fibrillationwas 1.63% a year in the intervention practices and 1.04% incontrol practices (difference 0.59%, 95% confidence interval0.20% to 0.98%). Systematic and opportunistic screening detectedsimilar numbers of new cases (1.62% v 1.64%, difference 0.02%,–0.5% to 0.5%).

Conclusion Active screening for atrial fibrillation detectsadditional cases over current practice. The preferred methodof screening in patients aged 65 or over in primary care isopportunistic pulse taking with follow-up electrocardiography.

Trial registration Current Controlled Trials ISRCTN19633732 [controlled-trials.com] .

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