Diagnosing atrial fibrillation in general practice

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39266.497396.BE (Published 23 August 2007) Cite this as: BMJ 2007;335:355
  1. Henk C P M van Weert, assistant professor of general practice
  1. Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Centre, Amsterdam, 1100 DD Netherlands
  1. h.c.vanweert{at}amc.uva.nl

    The combination of a clinical history, clinical signs, and an ECG will pick up most cases

    In this week's BMJ, Mant and colleagues and Fitzmaurice and colleagues present the results of the SAFE (screening for atrial fibrillation in the elderly) study. They assess how accurately general practitioners, practice nurses, and an interpretive computer program can diagnose atrial fibrillation on an electrocardiogram (ECG), and they report on the effectiveness of screening patients aged 65 and over for atrial fibrillation in British general practice.1 2 The prevalence of atrial fibrillation rises with age from 1.5% in people in their 60s to more than 10% in those over 90. People with atrial fibrillation have double the mortality and a four to fivefold higher risk of stroke than those without fibrillation. About a quarter of all strokes in elderly people are caused by atrial fibrillation. Strokes caused by atrial fibrillation are often severe and lead to high mortality and a low quality of life.3

    Even if normal rhythm cannot be restored, antiplatelet agents reduce the risk of stroke by around 22% and vitamin K antagonists, such as warfarin, reduce the risk by 64% …

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