Analysis

Experts agree on value of screening for irregular heartbeat in older people

A unique programme could be the way forward in detecting irregular heart rates and preventing strokes, study suggests. 

A unique screening programmecould be the way forward in detecting irregular heart rates and preventing strokes in older people, study suggests.

Screening programmes should to be introduced to detect irregular heart rates among older patients, according to an international collaboration of experts.

The call by AF-SCREEN a network of over 130 doctors, nurses and health economists comes after two years of debate and research into atrial fibrillation (AF).

While some nations have started testing different ways to screen their populations, AF-SCREEN says no one country has a comprehensive, mandated programme.

'Justified' call

But in a paper published in Circulation, the journal of the American Heart Association, it said the screening of people over

...

A unique screening programmecould be the way forward in detecting irregular heart rates and preventing strokes in older people, study suggests. 


Screening should be carried out during the NHS health checks for the over 65s, but there are
concerns this is not common everywhere. Picture: Getty Images

Screening programmes should to be introduced to detect irregular heart rates among older patients, according to an international collaboration of experts.

The call by AF-SCREEN – a network of over 130 doctors, nurses and health economists – comes after two years of debate and research into atrial fibrillation (AF).

While some nations have started testing different ways to screen their populations, AF-SCREEN says no one country has a comprehensive, mandated programme.

'Justified' call

But in a paper published in Circulation, the journal of the American Heart Association, it said the screening of people over the age of 65 in a clinic or the community was ‘justified’, given the level of undiagnosed AF and the risk of stroke.

In the UK one in five strokes are attributed to AF, but one in three people with the heart condition are undiagnosed.

500,000

Number of people in UK with undiagnosed atrial fibrillation

Source: Arrhythmia Alliance

The research found that if people with AF were treated with drugs the risk of stroke could be reduced four-fold.

The paper pointed to a study which found just 1% of those who have AF who were given treatment, had a stroke over the 18 months of the study, compared with 4% of those with AF who were not given treatment.

Variations

The paper said how screening systems would work would vary depending on the resources available to individual health systems. But it recommends – where possible – a manual pulse rhythm check with diagnosis followed by a mobile ECG device.

In the UK the national screening committee last looked at the issue in 2014, but ruled it out.

1 in 5

of all strokes are atrial fibrillation-related

Source: Arrhythmia Alliance

It is, however, considered good practice for screening to be carried out during the NHS health checks for the over 65s.

But UK charity Arrhythmia Alliance, which is one of the members of the AF-SCREEN collaboration, is concerned this does not always happen. In fact, it is currently carrying out a freedom of information investigation to gather the evidence.

'Screening can be run through GPs, pharmacies or in the community and carried out with manual pulse rhythm checks or with handheld mobile ECG devices. It is easy to do’

Trudie Lobban

The charity believes by making it a mandated programme it could prevent over 3,000 strokes a year – that is the figure Public Health England have put forward as the number of strokes where AF is only diagnosed afterwards.

Arrhythmia Alliance chief executive officer Trudie Lobban says: ‘In the UK we know there are over 500,000 people with undiagnosed AF, who are at risk of suffering a debilitating, life-threatening stroke. Screening can be run through GPs, pharmacies or in the community and carried out with manual pulse rhythm checks or with handheld mobile ECG devices. It is easy to do.’

She wants the UK national screening committee to again look at the issue – this was expected at the end of 2017, but it will be up to the next government to determine the priorities.

‘Last time the committee said the data wasn’t there to determine whether it was an effective step to take. Well it is now. I would urge them to act.’

She also believes nurses working with older patients can be more proactive in their day-to-day practice.

‘What I would say to nurses – and other health professionals – is to take people's pulses, it is simple and free to do. We used to do it, but it doesn’t happen so much anymore. We take blood pressure, but that doesn’t measure heart rate. When you greet people take their pulse and explain what AF is. It takes 30 seconds, requires no equipment and saves lives.’

Benefit

East Lancashire NHS Hospitals Trust nurse specialist Christopher Nicholson, who has worked in cardiac services, believes this will already be happening in primary care for at-risk groups and agrees ‘wholeheartedly’ with the overall message of widening checks.

‘Many people with asymptomatic AF can go some time before detection, that is a missed treatment opportunity which increases the risk, so getting more simple screening to detect it as early as possible must be a benefit. As well as stroke reduction, patients with AF are more likely to develop heart failure.’

3,000

People a year have strokes where atrial fibrillation is only diagnosed afterwards

Source: Arrhythmia Alliance

But he warns that diagnosis is not always straightforward. ‘Despite atrial fibrillation being the most common arrhythmia not all irregular pulses are AF. Also, not all irregularity in the pulse is clinically significant – everyone gets occasional ectopic beats, for example.’

What is more, he says, handheld ECG machines are ‘not yet reliable enough to be sure of the ECG rhythm in my experience’.

‘The best tool to get a firm AF diagnosis at present is a standard 12-lead ECG’ he adds.

‘I’m a nurse with atrial fibrillation’

Greg Moran, clinical facilitator for cardiology, Derby Teaching Hospitals NHS Foundation Trust

‘I first experienced AF when I was 50. I was working as a coronary care nurse and so I understood what was happening. Ten years later I know what my triggers are, I’m on regular medication and I haven't had an episode of AF for over two years. But unfortunately the overwhelming majority of people who experience AF don't have my level of knowledge and experience.

'They don't recognise what is happening to them or what the consequences might be.’

 

Further information


Nick Evans is a freelance health writer

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