Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial
Open accessAbstract
OBJECTIVES: To assess whether screening improves the detection of atrial fibrillation (cluster randomisation) and to compare systematic and opportunistic screening. DESIGN: Multicentred cluster randomised controlled trial, with subsidiary trial embedded within the intervention arm. SETTING: 50 primary care centres in England, with further individual randomisation of patients in the intervention practices. PARTICIPANTS: 14,802 patients aged 65 or over in 25 intervention and 25 control practices. INTERVENTIONS: Patients in intervention practices were randomly allocated to systematic screening (invitation for electrocardiography) or opportunistic screening (pulse taking and invitation for electrocardiography if the pulse was irregular). Screening took place over 12 months in each practice from October 2001 to February 2003. No active screening took place in control practices. MAIN OUTCOME MEASURE: Newly identified atrial fibrillation. RESULTS: The detection rate of new cases of atrial fibrillation was 1.63% a year in the intervention practices and 1.04% in control practices (difference 0.59%, 95% confidence interval 0.20% to 0.98%). Systematic and opportunistic screening detected similar numbers of new cases (1.62% v 1.64%, difference 0.02%, -0.5% to 0.5%). CONCLUSION: Active screening for atrial fibrillation detects additional cases over current practice. The preferred method of screening in patients aged 65 or over in primary care is opportunistic pulse taking with follow-up electrocardiography. TRIAL REGISTRATION: Current Controlled Trials ISRCTN19633732 [controlled-trials.com].
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Prompt recording of an ECG is an effective and cost-effective method to document chronic forms of AF.
“Prompt recording of an ECG is an effective and cost-effective method to document chronic forms of AF. 126”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [126]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Fitzmaurice, D. A., Hobbs, F. D. R., Jowett, S., Mant, J., Murray, E. T., Holder, R., Raftery, J. P., Bryan, S., Davies, M., Lip, G. Y. H., & Allan, T. F.
- Affiliations
- University of Birmingham (GB)
- University of Southampton (GB)
- Selly Oak Hospital (GB)
- Birmingham City Hospital (GB)
- City, University of London (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2007-08-02
- Volume
- 335
- Issue
- 7616
- Pages
- 383
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1952508
- OpenAlex
- W2020061893
- Cited by
- 405
- References
- 1
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 11 · 2023: 14 · 2022: 27 · 2021: 32 · 2020: 29 · 2019: 33 · 2018: 29 · 2017: 34 · 2016: 28 · 2015: 23 · 2014: 28 · 2013: 25 · 2012: 20
- FWCI
- 7.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, screening, systematic screening, opportunistic screening, electrocardiogram, pulse measurement, older adults, primary care, atrial fibrillation detection, irregular pulse
- MeSH terms
- Aged, Atrial Fibrillation, Electrocardiography, England, Family Practice, Humans, Mass Screening, Nurse Practitioners, Prognosis, Prevalence, Cluster Analysis
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