Detection of atrial fibrillation: evaluation of diagnostic methods and primary care based opportunistic screening

This thesis handles detection of atrial fibrillation (AF) in patients of 65 years and older. AF is an arrhythmia that can remain asymptomatic. Without treatment, it can lead to stroke, heart failure, and death. Detection and treatment are therefore important.
The study involved over eighteen thousand patients from 96 general practices. The practices were divided into intervention and control practices. The intervention group examined patients when they came for a consultation, irrespective of the reason ('opportunistic screening'). Practice workers took the pulse and used two devices with AF detection function: a sphygmomanometer and a single-lead electrocardiogram (ECG). Possible AF was checked with a 12-lead ECG. The control group provided usual care. After one year, the yield of AF was the same in both groups. Surprisingly, screening thus turned out as ineffective. The researchers therefore do not recommend opportunistic screening for AF in the Netherlands. Further research should examine the effectiveness of screening in different situations.