Proposed screening is too simple and not focused enoughBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2257 (Published 27 March 2012) Cite this as: BMJ 2012;344:e2257
A recent consensus conference organised by the Royal College of Physicians of Edinburgh recommended opportunistic pulse checking of people over 65 years by GPs, followed by electrocardiography for those with an irregular pulse.1 The aim is to identify people at an increased risk for stroke and adequate anticoagulation treatment of those detected.
However, this cheap and simple approach will probably not achieve its goal of preventing as many strokes as possible. A high proportion of strokes occur in people with paroxysmal atrial fibrillation only, and opportunistic pulse checks are unlikely to identify such short lasting episodes. Moreover, the accuracy of electrocardiography in identifying atrial fibrillation is far from ideal in primary care, as shown in the SAFE trial.2
The focus on people over 65 years ignores the fact that many younger people with atrial fibrillation have a high risk of stroke, if certain risk factors are present as expressed in the CHA2DS2-VASc score.3 The human and economic burden of stroke in this younger age group is particularly high.4
Such a screening programme should focus more on risk than on age groups and make use of more sophisticated but still relatively low priced methods, such as 24 hour electrocardiography, to increase sensitivity. Training in and assistance with new methods should be provided by cardiology experts in secondary care.
Cite this as: BMJ 2012;344:e2257
Competing interests: None declared.
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