Why screen for AF?

Atrial fibrillation may not be associated with any symptoms, but is linked to increased risk of stroke, heart attack, dementia and premature death. About 10 in 100 (10%) of strokes happen in people unaware that they have atrial fibrillation. However, therapy with medication (anticoagulant) is highly effective at reducing the risk.

At present, some GPs look for atrial fibrillation opportunistically by simply taking the pulse of patients who could be visiting for any reason, or using a diagnostic device such as a hand-held electrocardiogram (ECG). However, this is not done in a systematic way, and only in some general practices.

One problem with the current approach is that some people do not have atrial fibrillation all the time but go into and out of an irregular heart rhythm (known as paroxysmal or intermittent AF). So in this research, patients will be loaned a handheld ECG recorder, provided by Zenicor, to measure a (single lead) ECG at home for 2-4 weeks.

“This novel technique, the first time home screening has been used on this scale in the NHS, will detect intermittent atrial fibrillation that otherwise would be missed in a one-off test at a GP appointment,” said Professor Mant, who is leading the research.

The programme of research will include a cost effectiveness analysis to assess whether screening is a good use of NHS resources. Researchers will also observe what goes on in general practices when screening is carried out and interview staff and patients to explore issues around consent to screening and patient concerns.

The UK National Screening Committee has welcomed this trial of systematic population screening for atrial fibrillation. Professor Robert Steele, Independent Chair of the UK National Screening Committee, and Prof Anne Mackie, Director of Screening at Public Health England, said:

“Screening for atrial fibrillation, which is a major cause of morbidity and death, would seem to be an excellent idea, but it is only by robust research coupled with economic analysis can we be sure that the benefit of screening outweighs any harm that it may cause and that it is cost effective.

“The UK National Screening Committee is frequently asked to assess the evidence for introducing national screening programmes for a wide variety of conditions, and in most instances such evidence is lacking. It is really heartening to see a first rate research team tackling this issue for such an important condition, and we are eagerly looking forward to the results which will have the potential to affect screening policy across the United Kingdom.”

To read the current recommendation on AF screening and the role of the SAFER programme please see this UK National Screening Committee link.

To find out more about population level screening, please see this Public Health England website explaining what it is, how it works and its limitations.