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Screening for undiagnosed atrial fibrillation using a single-lead electrocardiogram at primary care visits: patient uptake and practitioner perspectives from the VITAL-AF trial
CONCLUSIONS: Though the benefits and harms of screening for AF remain uncertain, most older patients underwent screening and PCPs were able to manage SL-ECG results, supporting the feasibility of routine primary care screening. PCPs exposed to a SL-ECG device preferred it over pulse palpation. PCPs were largely uncertain about AF screening done outside of practice visits.TRIAL REGISTRATION: ClinicalTrials.gov NCT03515057. Registered May 3, 2018.PMID:37391738 | DOI:10.1186/s12875-023-02087-5
Source: Primary Care - June 30, 2023 Category: Primary Care Authors: Steven J Atlas Jeffrey M Ashburner Yuchiao Chang Leila H Borowsky Patrick T Ellinor David D McManus Steven A Lubitz Daniel E Singer Source Type: research

Detection of occult atrial fibrillation with 24-hour ECG after cryptogenic acute stroke or transient ischaemic attack: A retrospective cross-sectional study in a primary care database in Israel
CONCLUSION: 24-hour Holter has a low AF/AFL detection rate. Older persons and those with hypertension or CKD are more likely to be detected with AF/AFL using this method.PMID:34240675 | DOI:10.1080/13814788.2021.1947237
Source: European Journal of General Practice - July 9, 2021 Category: Primary Care Authors: Ori Liran Tamar Banon Alon Grossman Source Type: research

A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy
AbstractPurpose of ReviewTo highlight pharmacological and non-pharmacological approaches to reversing hypertensive left ventricular hypertrophy (LVH). We identify high-risk phenotypes that may benefit from aggressive blood pressure (BP) management to prevent incident outcomes such as the development of atherosclerotic cardiovascular disease, stroke, and heart failure.Recent FindingsLVH is a modifiable risk factor. Intensive BP lowering (systolic BP<  120 mmHg) induces greater regression of electrocardiographic LVH than standard BP targets. The optimal agents for inducing LVH regression include renin–angiotensinogen...
Source: Current Hypertension Reports - September 4, 2020 Category: Primary Care Source Type: research

Opportunistic screening versus usual care for diagnosing atrial fibrillation in general practice: a cluster randomised controlled trial.
CONCLUSION: Opportunistic screening with a single-lead ECG at the discretion of the GP did not result in a higher yield of newly detected cases of AF in patients aged ≥65 years in the community than usual care. For higher participation rates in future studies, more rigorous screening methods are needed. PMID: 31988084 [PubMed - as supplied by publisher]
Source: The British Journal of General Practice - January 26, 2020 Category: Primary Care Authors: Kaasenbrood F, Hollander M, de Bruijn SH, Dolmans CP, Tieleman RG, Hoes AW, Rutten FH Tags: Br J Gen Pract Source Type: research

USPSTF: Evidence Lacking on Screening for AFib With ECG
On Aug. 7, the U.S. Preventive Services Task Force posted a final recommendation statement and final evidence summary on screening for atrial fibrillation with electrocardiography to prevent stroke.
Source: AAFP News - August 15, 2018 Category: Primary Care Source Type: news

Screening of older patients for atrial fibrillation in general practice: Current evidence and its implications for future practice.
CONCLUSIONS: It was determined that improved detection and diagnosis of AF, combined with appropriate anticoagulation strategies, will be crucial for improving stroke prevention and reducing its associated social and economic costs. PMID: 29034749 [PubMed - in process]
Source: European Journal of General Practice - October 18, 2017 Category: Primary Care Tags: Eur J Gen Pract Source Type: research

Diagnosis and Treatment of Atrial Fibrillation.
Abstract Atrial fibrillation is a supraventricular arrhythmia that adversely affects cardiac function and increases the risk of stroke. It is the most common arrhythmia and a major source of morbidity and mortality; its prevalence increases with age. Pulse rate is sensitive, but not specific, for diagnosis, and suspected atrial fibrillation should be confirmed with 12-lead electrocardiography. Because normal electrocardiographic findings do not rule out atrial fibrillation, home monitoring is recommended if there is clinical suspicion of arrhythmia despite normal test results. Treatment is based on decisions made ...
Source: American Family Physician - September 14, 2016 Category: Primary Care Authors: Gutierrez C, Blanchard DG Tags: Am Fam Physician Source Type: research

The use of a portable three-lead ECG monitor to detect atrial fibrillation in general practice.
CONCLUSIONS: The inexpensive portable PEM device recording diagnosed AF with a high sensitivity and specificity. KEY POINTS Simple ECG monitors could be useful to identify atrial fibrillation and thereby lead to a better prevention of stroke. The PEM device was easy to use and 95.7% of the recordings were technically acceptable for detecting atrial fibrillation. The PEM device has a high sensitivity and specificity in detecting atrial fibrillation compared to a standard 12-lead ECG. Further studies should evaluate the clinical usefulness of the PEM device, e.g. to detect intermittent atrial fibrillation. PMID: 2740915...
Source: Primary Care - July 12, 2016 Category: Primary Care Authors: Kristensen AN, Jeyam B, Riahi S, Jensen MB Tags: Scand J Prim Health Care Source Type: research

Adherence of doctors to a clinical guideline for hypertension in Bojanala district, North-West Province, South Africa.
CONCLUSION: Overall adherence of doctors to treatment guidelines for hypertension was found to be low (51.9%). Low adherence rates were related to age (older doctors) and less clinical experience, and differed with regard to various aspects of the guidelines. PMID: 26245596 [PubMed - in process]
Source: Primary Care - August 8, 2015 Category: Primary Care Authors: Adedeji AR, Tumbo J, Govender I Tags: Afr J Prim Health Care Fam Med Source Type: research

Is screening for AF worthwhile? Stroke risk in a screened population from the SAFE study
Conclusion. Stroke risk profiles of patients detected via opportunistic and systematic screenings were similar. Data derived from the SAFE study suggest that active screening for AF in patients aged ≥65 years in primary care is a useful screening programme with 78–83% of patients identified eligible for anticoagulation treatment according to the CHADS2 criteria.
Source: Family Practice - May 17, 2014 Category: Primary Care Authors: Fitzmaurice, D. A., McCahon, D., Baker, J., Murray, E. T., Jowett, S., Sandhar, H., Holder, R. L., Hobbs, F. D. R. Tags: Epidemiology Source Type: research

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