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| [[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]|| <br> || <br> | |||
| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
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| [[File:Critical_pathways_.gif|88px|link=Atrial fibrillation critical pathways]]|| <br> || <br> | |||
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| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]] | |||
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]] | |||
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{{Template:Atrial fibrillation}} | {{Template:Atrial fibrillation}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Anahita}} | ||
==Overview== | ==Overview== | ||
[[ | Early [[diagnosis]] of [[atrial fibrillation]] and proper [[Prophylaxis|prophylactic]] [[treatment]] can prevent numerous related [[Complication (medicine)|complications]], such as [[stroke]] and [[mortality rate|mortality]]. Since [[patients]] older than 65 are more prone to [[atrial fibrillation]] and the aforementioned [[Complication (medicine)|complications]], it has been recommended to perform [[Screening (medicine)|screening]] at least in this age group. [[Electrocardiogram]] (12-lead [[electrocardiogram|ECG]]) has been introduced as the gold standard method for [[atrial fibrillation]] [[Screening (medicine)|screening]]. Nevertheless [[atrial fibrillation]] [[Screening (medicine)|screening]] can be done by simply checking [[pulse]]. The other reason to support [[atrial fibrillation]] [[Screening (medicine)|screening]] is the cost effectiveness of it. | ||
The estimated [[sensitivity (tests)|sensitivity]] of the routine primary care visit in the detection of atrial fibrillation is 64%. | ==Screening== | ||
Practice guidelines by the European Society of Cardiology (ESC recommend<ref name="pmid32860505">{{cite journal| author=Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C | display-authors=etal| title=2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. | journal=Eur Heart J | year= 2021 | volume= 42 | issue= 5 | pages= 373-498 | pmid=32860505 | doi=10.1093/eurheartj/ehaa612 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32860505 }} </ref>: | |||
* "Opportunistic screening for AF by pulse taking or ECG rhythm strip is recommended in patients >_65 years of age" | |||
* "It is recommended to interrogate pacemakers and implantable cardioverter defibrillators on a regular basis for AHRE" | |||
* "Systematic ECG screening should be considered to detect AF in individuals aged >_75 years, or those at high risk of stroke.2" | |||
A [[systematic review]] of trials through November, 2019 by the Cochrance Collaboration concluded<ref name="pmid27258214">{{cite journal| author=Moran PS, Teljeur C, Ryan M, Smith SM| title=Systematic screening for the detection of atrial fibrillation. | journal=Cochrane Database Syst Rev | year= 2016 | volume= | issue= 6 | pages= CD009586 | pmid=27258214 | doi=10.1002/14651858.CD009586.pub3 | pmc=7105908 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27258214 }} </ref>: | |||
* " Evidence suggests that systematic screening and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice" | |||
[[Randomized controlled trial]]s have looked at various screening methods: | |||
* Implantable loop recorders increased detection, but did not reduce morbidity<ref name="pmid34469766">{{cite journal| author=Svendsen JH, Diederichsen SZ, Højberg S, Krieger DW, Graff C, Kronborg C | display-authors=etal| title=Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial. | journal=Lancet | year= 2021 | volume= | issue= | pages= | pmid=34469766 | doi=10.1016/S0140-6736(21)01698-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34469766 }} </ref> | |||
* Intermittent [[The electrocardiogram|electrocardiograms]] ([[The electrocardiogram|ECGs]]) for 14 days reduced a "composite of stroke, systemic embolism, bleeding hospitalization, and death"<ref name="pmid34469764">{{cite journal| author=Svennberg E, Friberg L, Frykman V, Al-Khalili F, Engdahl J, Rosenqvist M| title=Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial. | journal=Lancet | year= 2021 | volume= | issue= | pages= | pmid=34469764 | doi=10.1016/S0140-6736(21)01637-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34469764 }} </ref><ref name="pmid9505919">{{cite journal| author=Wheeldon NM, Tayler DI, Anagnostou E, Cook D, Wales C, Oakley GD| title=Screening for atrial fibrillation in primary care. | journal=Heart | year= 1998 | volume= 79 | issue= 1 | pages= 50-5 | pmid=9505919 | doi=10.1136/hrt.79.1.50 | pmc=1728588 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9505919 }} </ref><ref name="pmid15155965">{{cite journal| author=Jabaudon D, Sztajzel J, Sievert K, Landis T, Sztajzel R| title=Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack. | journal=Stroke | year= 2004 | volume= 35 | issue= 7 | pages= 1647-51 | pmid=15155965 | doi=10.1161/01.STR.0000131269.69502.d9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15155965 }} </ref> | |||
* A study of routine [[pulse]] check or [[electrocardiogram]] during routine office visits found that the annual rate of [[atrial fibrillation]] [[diagnosis]] in [[old age|elderly]] [[patients]] improved from 1.04% to 1.63%. Since identification of such [[patients]] for [[Prophylaxis|prophylactic]] [[anticoagulation]] might in turn reduce the risk of [[stroke]] in that age category.<ref name="pmid17673732">{{cite journal| author=Fitzmaurice DA, Hobbs FD, Jowett S, Mant J, Murray ET, Holder R et al.| title=Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. | journal=BMJ | year= 2007 | volume= 335 | issue= 7616 | pages= 383 | pmid=17673732 | doi=10.1136/bmj.39280.660567.55 | pmc=PMC1952508 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17673732 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18375698 Review in: Evid Based Med. 2008 Apr;13(2):45] </ref> | |||
** The estimated [[sensitivity (tests)|sensitivity]] of the routine primary care visit in the detection of [[atrial fibrillation]] is 64%. This low [[sensitivity (tests)|sensitivity]] probably reflects the fact that the [[pulse]] is not being checked routinely or carefully.<ref name="pmid17673732">{{cite journal| author=Fitzmaurice DA, Hobbs FD, Jowett S, Mant J, Murray ET, Holder R et al.| title=Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. | journal=BMJ | year= 2007 | volume= 335 | issue= 7616 | pages= 383 | pmid=17673732 | doi=10.1136/bmj.39280.660567.55 | pmc=PMC1952508 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17673732 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18375698 Review in: Evid Based Med. 2008 Apr;13(2):45] </ref> | |||
===Cost effectiveness=== | |||
*The other reason to support [[atrial fibrillation]] [[Screening (medicine)|screening]] is the cost effectiveness of it. Based on several studies, since [[Screening (medicine)|screening]] prevent numerous [[atrial fibrillation]]'s [[Complication (medicine)|complications]] (such as [[stroke]] and [[mortality rate|mortality]]). <ref name="pmid27733465">{{cite journal| author=Jacobs MS, Kaasenbrood F, Postma MJ, van Hulst M, Tieleman RG| title=Cost-effectiveness of screening for atrial fibrillation in primary care with a handheld, single-lead electrocardiogram device in the Netherlands. | journal=Europace | year= 2018 | volume= 20 | issue= 1 | pages= 12-18 | pmid=27733465 | doi=10.1093/europace/euw285 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27733465 }} </ref><ref name="pmid23904073">{{cite journal| author=Mayer F, Stahrenberg R, Gröschel K, Mostardt S, Biermann J, Edelmann F | display-authors=etal| title=Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia. | journal=Clin Res Cardiol | year= 2013 | volume= 102 | issue= 12 | pages= 875-84 | pmid=23904073 | doi=10.1007/s00392-013-0601-2 | pmc=3826055 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23904073 }} </ref> | |||
*Other methods such as 7 days [[Holter monitor|Holter monitoring]] also could be considered for [[atrial fibrillation]] [[Screening (medicine)|screening]].<ref name="pmid23904073">{{cite journal| author=Mayer F, Stahrenberg R, Gröschel K, Mostardt S, Biermann J, Edelmann F | display-authors=etal| title=Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia. | journal=Clin Res Cardiol | year= 2013 | volume= 102 | issue= 12 | pages= 875-84 | pmid=23904073 | doi=10.1007/s00392-013-0601-2 | pmc=3826055 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23904073 }} </ref> | |||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
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{{WS}} | |||
[[CME Category::Cardiology]] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Electrophysiology]] | [[Category:Electrophysiology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 06:23, 13 October 2021
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Resident Survival Guide |
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Sinus rhythm  |
Atrial fibrillation  |
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Atrial Fibrillation Microchapters | |
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Special Groups | |
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Diagnosis | |
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Treatment | |
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Cardioversion | |
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Anticoagulation | |
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Surgery | |
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Case Studies | |
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Atrial fibrillation screening On the Web | |
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Directions to Hospitals Treating Atrial fibrillation screening | |
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Risk calculators and risk factors for Atrial fibrillation screening | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
Early diagnosis of atrial fibrillation and proper prophylactic treatment can prevent numerous related complications, such as stroke and mortality. Since patients older than 65 are more prone to atrial fibrillation and the aforementioned complications, it has been recommended to perform screening at least in this age group. Electrocardiogram (12-lead ECG) has been introduced as the gold standard method for atrial fibrillation screening. Nevertheless atrial fibrillation screening can be done by simply checking pulse. The other reason to support atrial fibrillation screening is the cost effectiveness of it.
Screening
Practice guidelines by the European Society of Cardiology (ESC recommend[1]:
- "Opportunistic screening for AF by pulse taking or ECG rhythm strip is recommended in patients >_65 years of age"
- "It is recommended to interrogate pacemakers and implantable cardioverter defibrillators on a regular basis for AHRE"
- "Systematic ECG screening should be considered to detect AF in individuals aged >_75 years, or those at high risk of stroke.2"
A systematic review of trials through November, 2019 by the Cochrance Collaboration concluded[2]:
- " Evidence suggests that systematic screening and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice"
Randomized controlled trials have looked at various screening methods:
- Implantable loop recorders increased detection, but did not reduce morbidity[3]
- Intermittent electrocardiograms (ECGs) for 14 days reduced a "composite of stroke, systemic embolism, bleeding hospitalization, and death"[4][5][6]
- A study of routine pulse check or electrocardiogram during routine office visits found that the annual rate of atrial fibrillation diagnosis in elderly patients improved from 1.04% to 1.63%. Since identification of such patients for prophylactic anticoagulation might in turn reduce the risk of stroke in that age category.[7]
- The estimated sensitivity of the routine primary care visit in the detection of atrial fibrillation is 64%. This low sensitivity probably reflects the fact that the pulse is not being checked routinely or carefully.[7]
Cost effectiveness
- The other reason to support atrial fibrillation screening is the cost effectiveness of it. Based on several studies, since screening prevent numerous atrial fibrillation's complications (such as stroke and mortality). [8][9]
- Other methods such as 7 days Holter monitoring also could be considered for atrial fibrillation screening.[9]
References
- ↑ Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C; et al. (2021). "2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC". Eur Heart J. 42 (5): 373–498. doi:10.1093/eurheartj/ehaa612. PMID 32860505 Check
|pmid=value (help). - ↑ Moran PS, Teljeur C, Ryan M, Smith SM (2016). "Systematic screening for the detection of atrial fibrillation". Cochrane Database Syst Rev (6): CD009586. doi:10.1002/14651858.CD009586.pub3. PMC 7105908 Check
|pmc=value (help). PMID 27258214. - ↑ Svendsen JH, Diederichsen SZ, Højberg S, Krieger DW, Graff C, Kronborg C; et al. (2021). "Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial". Lancet. doi:10.1016/S0140-6736(21)01698-6. PMID 34469766 Check
|pmid=value (help). - ↑ Svennberg E, Friberg L, Frykman V, Al-Khalili F, Engdahl J, Rosenqvist M (2021). "Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial". Lancet. doi:10.1016/S0140-6736(21)01637-8. PMID 34469764 Check
|pmid=value (help). - ↑ Wheeldon NM, Tayler DI, Anagnostou E, Cook D, Wales C, Oakley GD (1998). "Screening for atrial fibrillation in primary care". Heart. 79 (1): 50–5. doi:10.1136/hrt.79.1.50. PMC 1728588. PMID 9505919.
- ↑ Jabaudon D, Sztajzel J, Sievert K, Landis T, Sztajzel R (2004). "Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack". Stroke. 35 (7): 1647–51. doi:10.1161/01.STR.0000131269.69502.d9. PMID 15155965.
- ↑ 7.0 7.1 Fitzmaurice DA, Hobbs FD, Jowett S, Mant J, Murray ET, Holder R; et al. (2007). "Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial". BMJ. 335 (7616): 383. doi:10.1136/bmj.39280.660567.55. PMC 1952508. PMID 17673732. Review in: Evid Based Med. 2008 Apr;13(2):45
- ↑ Jacobs MS, Kaasenbrood F, Postma MJ, van Hulst M, Tieleman RG (2018). "Cost-effectiveness of screening for atrial fibrillation in primary care with a handheld, single-lead electrocardiogram device in the Netherlands". Europace. 20 (1): 12–18. doi:10.1093/europace/euw285. PMID 27733465.
- ↑ 9.0 9.1 Mayer F, Stahrenberg R, Gröschel K, Mostardt S, Biermann J, Edelmann F; et al. (2013). "Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia". Clin Res Cardiol. 102 (12): 875–84. doi:10.1007/s00392-013-0601-2. PMC 3826055. PMID 23904073.