Screening and management of atrial fibrillation in primary care

Ponamgi, Shiva; Siontis, Konstantinos C.; Rushlow, David R.; Graff‐Radford, Jonathan; Montori, Víctor M.; Noseworthy, Peter A.

doi:10.1136/bmj.n379

Cited by 13 publications

(5 citation statements)

References 176 publications

(206 reference statements)

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“… 21 , 22 However, the public health relevance of targeted screening to detect AF in low-resource settings such as China is uncertain. 23 …”

Section: Introductionmentioning

confidence: 99%

Correlates and consequences of atrial fibrillation in a prospective study of 25 000 participants in the China Kadoorie Biobank

Turnbull,

Camm,

Halsey

et al. 2024

European Heart Journal Open

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Background and Aims The prevalence of atrial fibrillation (AF) is positively correlated with prior cardiovascular diseases (CVD) and CVD risk factors, but is lower in Chinese than Europeans despite their higher burden of CVD. We examined the prevalence and prognosis of AF and other ECG abnormalities in the China Kadoorie Biobank. Methods A random sample of 25,239 adults (mean age 59.5 years, 62% women) had a 12-lead ECG recorded and interpreted using a Mortara VERITAS™ algorithm in 2013-2014. Participants were followed-up for 5 years for incident stroke, ischaemic heart disease (IHD), heart failure (HF) and all CVD, overall and by CHA2DS2-VASc scores, age, sex, and area. Results Overall, 1.2% had AF, 13.6% had left ventricular hypertrophy (LVH), and 28.1% had ischaemia (two-thirds of AF cases also had ischaemia or LVH). The prevalence of AF increased with age, prior CVD and levels of CHA₂DS₂-VASc scores (0.5%, 1.3%, 2.1%, 2.9%, and 4.4% for scores <2, 2, 3, 4, ≥ 5, respectively). AF was associated with 2-fold higher hazard ratios (HR) for CVD (2.15; 95% CI, 1.71–2.69) and stroke (1.88; 1.44–2.47), and a 4-fold higher HR for HF (3.79; 2.21–6.49). The 5-year cumulative incidence of CVD was comparable for AF, prior CVD and CHA₂DS₂-VASc scores ≥2 (36.7% vs 36.2% vs 37.7%, respectively), but was 2-fold greater than for ischaemia (19.4%), LVH (18.0%) or normal ECG (14.1%), respectively. Conclusions The findings highlight the importance of screening for AF together with estimation of CHA₂DS₂-VASc scores for prevention of CVD in Chinese adults.

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“… 21 , 22 However, the public health relevance of targeted screening to detect AF in low-resource settings such as China is uncertain. 23 …”

Section: Introductionmentioning

confidence: 99%

Correlates and consequences of atrial fibrillation in a prospective study of 25 000 participants in the China Kadoorie Biobank

Turnbull,

Camm,

Halsey

et al. 2024

European Heart Journal Open

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“…Pharmacist-led atrial fibrillation screening programmes appear to have demonstrated feasibility across a variety of clinical and non-clinical settings, [4][5][6][7][8][9][10][11][12][14][15][16] To be valuable, any screening programme must be precise, and there must be a robust infrastructure to support effective and safe referral and follow-up in the event of positive screening. 56 There is a paucity of cost-effectiveness data to accompany the studies, and use of a cross-sectional design limited study follow-up, for example, not all studies quantified the number of new atrial fibrillation cases. To support implementation of atrial fibrillation screening programmes, studies need to demonstrate that the associated expenditure translates into a reduced burden on health and social care services.…”

Section: Discussionmentioning

confidence: 99%

Integrated Care for Atrial Fibrillation Management: The Role of the Pharmacist

Ritchie¹,

Penson²,

Akpan³

et al. 2022

The American Journal of Medicine

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“…With a low threshold for patient encounters, and with medical specialists reporting their findings back to primary care, general practitioners (GPs) are well situated for early signalling of symptoms of progressing cardiovascular disease, as well as for having an adequate overview of patients’ risk factors. 5 Furthermore, primary care is important for the follow-up of chronic diseases and for supporting treatment adherence, including in AF. This makes primary care one of the settings with high opportunities to perform screening interventions for AF.…”

Section: Introductionmentioning

confidence: 99%

Screening and detection of atrial fibrillation in primary care: current practice and future perspectives

Brik,

Harskamp,

Himmelreich

2024

European Heart Journal Supplements

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Atrial fibrillation (AF) is a common arrhythmia associated with an increased risk of stroke, which can be effectively reduced by prophylaxis initiation and integrated care to reduce cardiovascular risk and AF-related complications. Screening for AF has the potential to improve long-term clinical outcomes through timely AF detection in asymptomatic patients. With the central role of primary care in most European healthcare systems in terms of disease detection, treatment, as well as record keeping, primary care is ideally situated as a setting for AF screening efforts. In this review, we provide an overview of evidence relating to AF screening in primary care. We discuss current practices of AF detection and screening, evidence from AF screening trials conducted in primary care settings, stakeholder views on barriers and facilitators for AF screening in primary care, and important aspects that will likely shape routine primary care AF detection as well as AF screening efforts. Finally, we present a potential outline for a primary care–centred AF screening trial coupled to integrated AF care that could further improve the benefit of AF screening.

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Screening and management of atrial fibrillation in primary care

Cited by 13 publications

References 176 publications

Correlates and consequences of atrial fibrillation in a prospective study of 25 000 participants in the China Kadoorie Biobank

Correlates and consequences of atrial fibrillation in a prospective study of 25 000 participants in the China Kadoorie Biobank

Integrated Care for Atrial Fibrillation Management: The Role of the Pharmacist

Screening and detection of atrial fibrillation in primary care: current practice and future perspectives

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