Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: A cluster-controlled clinical trial

Virginia González Blanco, Luis Ángel Pérula de Torres, Enrique Martín Rioboó, Miguel Ángel Martínez Adell, Juan Manuel Parras Rejano, Jesús González Lama, Javier Ruiz Moruno, Remedios Martín Alvarez, José Ángel Fernández García, Joaquin Ruiz de Castroviejo, Ana Roldán Villalobos, Roger Ruiz Moral, grupo de estudio colaborativo DOFA-AP, Virginia González Blanco, Luis Ángel Pérula de Torres, Enrique Martín Rioboó, Miguel Ángel Martínez Adell, Juan Manuel Parras Rejano, Jesús González Lama, Javier Ruiz Moruno, Remedios Martín Alvarez, José Ángel Fernández García, Joaquin Ruiz de Castroviejo, Ana Roldán Villalobos, Roger Ruiz Moral, grupo de estudio colaborativo DOFA-AP

Abstract

Objective: The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged≥65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated.

Material and methods: This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the experimental group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the control group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation.

Results: A total of 5,465 patients with a mean age of 75.61 years were recruited for the EG, and 1,525 patients with a mean age of 74.07 years were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3 and 15.0% of the patients in the EG and the CG, respectively (P<.001). A total of 164 new cases of atrial fibrillation were detected (2.3%), 1.1% in the EG and 6.7% in the CG (adjusted OR: 0.29; 95% CI 0.18-0.45).

Conclusions: Case finding for atrial fibrillation in patients aged≥65 years with symptoms or signs suggestive of atrial fibrillation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients.

Trial registration: The trial is registered in ClinicalTrials.gov (NCT01291953; February 8, 2011).

Keywords: Atrial fibrillation; Búsqueda de casos; Case finding; Cribado oportunista; Fibrilación auricular; Heart rhythm disorders; Opportunistic screening; Trastornos del ritmo cardiaco.

Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Source: PubMed

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