Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial.

OBJECTIVES

To assess whether screening improves the detection of atrial fibrillation (cluster randomisation) and to compare systematic and opportunistic screening.

DESIGN

Multicentred cluster randomised controlled trial, with subsidiary trial embedded within the intervention arm.

SETTING

50 primary care centres in England, with further individual randomisation of patients in the intervention practices.

PARTICIPANTS

14,802 patients aged 65 or over in 25 intervention and 25 control practices.

INTERVENTIONS

Patients in intervention practices were randomly allocated to systematic screening (invitation for electrocardiography) or opportunistic screening (pulse taking and invitation for electrocardiography if the pulse was irregular). Screening took place over 12 months in each practice from October 2001 to February 2003. No active screening took place in control practices.

MAIN OUTCOME MEASURE

Newly identified atrial fibrillation.

RESULTS

The detection rate of new cases of atrial fibrillation was 1.63% a year in the intervention practices and 1.04% in control practices (difference 0.59%, 95% confidence interval 0.20% to 0.98%). Systematic and opportunistic screening detected similar numbers of new cases (1.62% v 1.64%, difference 0.02%, -0.5% to 0.5%).

CONCLUSION

Active screening for atrial fibrillation detects additional cases over current practice. The preferred method of screening in patients aged 65 or over in primary care is opportunistic pulse taking with follow-up electrocardiography.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN19633732 [controlled-trials.com].