Research

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

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39280.660567.55 (Published 23 August 2007) Cite this as: BMJ 2007;335:383
  1. David A Fitzmaurice, professor of primary care1,
  2. F D Richard Hobbs, professor, head of department1,
  3. Sue Jowett, research fellow1,
  4. Jonathon Mant, reader1,
  5. Ellen T Murray, research fellow1,
  6. Roger Holder, head of statistics1,
  7. J P Raftery, professor of health technology assessment2,
  8. S Bryan, professor of health economics3,
  9. Michael Davies, consultant cardiologist4,
  10. Gregory Y H Lip, professor of cardiovascular medicine5,
  11. T F Allan, senior lecturer6
  1. 1Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT
  2. 2Wessex Institute for Health Research and Development, University of Southampton
  3. 3Health Economics Facility, University of Birmingham
  4. 4Selly Oak Hospital, Birmingham
  5. 5University Department of Medicine, City Hospital, Birmingham
  6. 6Health Care Research Unit, St Bartholomew's School of Nursing and Midwifery, City University, London
  1. Correspondence to: F D R Hobbs f.d.r.hobbs{at}bham.ac.uk
  • Accepted 29 June 2007

Abstract

Objectives To assess whether screening improves the detection of atrial fibrillation (cluster randomisation) and to compare systematic and opportunistic screening.

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

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

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

Interventions Patients in intervention practices were randomly allocated to systematic screening (invitation for electrocardiography) or opportunistic screening (pulse taking and invitation for electrocardiography if the pulse was irregular). Screening took place over 12 months in each practice from October 2001 to February 2003. No active screening took place in control practices.

Main outcome measure Newly identified atrial fibrillation.

Results The detection rate of new cases of atrial fibrillation was 1.63% a year in the intervention practices and 1.04% in control practices (difference 0.59%, 95% confidence interval 0.20% to 0.98%). Systematic and opportunistic screening detected similar numbers of new cases (1.62% v 1.64%, difference 0.02%, −0.5% to 0.5%).

Conclusion Active screening for atrial fibrillation detects additional cases over current practice. The preferred method of screening in patients aged 65 or over in primary care is opportunistic pulse taking with follow-up electrocardiography.

Trial registration Current Controlled Trials ISRCTN19633732.

Footnotes

  • ARTICLE
  • Contributors: DAF and FDRH were principal investigators. SJ was research fellow for the project. JM was joint grant holder. ETM was project manager. RH was head of statistics. JPR was joint grant holder and contributed to study design. SB was principal health economist for the study. MD and GYHL were joint grant holders and read the electrocardiograms. TFA was joint grant holder and study statistician. DAF, FDRH, SJ, JM, and RH wrote the paper. DAF is guarantor.

  • Funding: NHS research and development health technology assessment programme (No 96/22/11).

  • Competing interests: None declared.

  • Ethical approval: West Midlands multicentre research ethical committee.

    Provenance and peer review: Non-commissioned, externally peer reviewed.

  • Accepted 29 June 2007
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