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People over 65 should be screened for atrial fibrillation, say stroke specialists

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e1644 (Published 05 March 2012) Cite this as: BMJ 2012;344:e1644
  1. Bryan Christie
  1. 1Edinburgh

Stroke specialists from across the United Kingdom are calling for a national screening programme to be developed as a matter of urgency to improve detection of atrial fibrillation and prevent up to 2000 premature deaths a year.

This is the main recommendation from a two day consensus conference organised by the Royal College of Physicians of Edinburgh. It also said that aspirin should not be used to prevent stroke in people with atrial fibrillation and that underprescribing of anticoagulant drugs “should be addressed.”

Atrial fibrillation is easily treated with drugs such as warfarin, but evidence indicates that up to half of patients who could benefit from treatment are not receiving it. The condition, which will affect one in four people at some time in their lives, contributes to 15% of stroke cases and deaths in the UK. It is estimated that 5000 strokes and 2000 premature deaths could be avoided through effective detection and treatment.

The statement approved by the conference states: “Screening for AF [atrial fibrillation] in people of 65 or older satisfies the UK National Screening Committee criteria for a screening programme and such a national screening programme should be undertaken in the UK.” It says that the most cost effective screening method would be opportunistic pulse checking of people over 65 by GPs, followed by electrocardiogram examination for those with an irregular pulse.

Aspirin is often used as an alternative to warfarin, but the statement says that it is ineffective in stroke prevention in people with atrial fibrillation and should not be used. It expresses concern at the underprescribing of anticoagulants by doctors who assume that patients are not willing or able to take the drugs safely. It says that more research is needed among healthcare professionals and patients to overcome the barriers to optimal use of anticoagulants.

Scott Ramsay, a consultant in stroke medicine and the lead organiser for consensus conferences at the Royal College of Physicians of Edinburgh, said, “Atrial fibrillation is often a silent condition with serious consequences in the form of stroke. There has been uncertainty among doctors regarding how to treat it effectively and a lack of medical and public awareness about sufferers’ significantly increased risk of developing a stroke. This is an issue of national significance, and we have reached consensus that national screening programmes should be introduced throughout the UK for all people over 65 as a matter of urgency.

“In addition, it is clear that the evidence has moved on and that historical methods of stroke prevention in atrial fibrillation, such as prescribing aspirin instead of anticoagulants, have proved to be ineffective but have significant side effects. For all patients in atrial fibrillation, except those few at truly low risk of stroke, anticoagulation is the only effective stroke prevention and should be offered as treatment.”

Gregory Lip, professor of cardiovascular medicine at the University of Birmingham and a member of the organising committee, said, “Atrial fibrillation is a treatable illness and need not result in stroke. As doctors, it is vital that we recognise that many deaths could be avoided if we improve awareness, diagnosis, and treatment of this common heart condition.”

Notes

Cite this as: BMJ 2012;344:e1644