Smyth B, Marsden P, Corcoran R, Walsh R, Brennan C, McSharry K, Clarke J, Kelly P J, Harbison J
From the 1Department of Public Health, National Clinical Programme for Stroke, Galway, Ireland.
Department of Public Health, National Clinical Programme for Stroke, Tullamore, Ireland.
QJM. 2016 Aug;109(8):539-543. doi: 10.1093/qjmed/hcw011. Epub 2016 Jan 27.
Opportunistic screening is an effective means of identifying subjects with Atrial Fibrillation (AF). Previous studies of opportunistic screening have been performed areas with high population density and before the development of novel oral anticoagulant drugs. We performed a study to determine feasibility of AF screening in a predominantly rural, low population density area.
Over 6 months, subjects 65 years and older were screened by local General Practitioners using radial pulse palpation confirmed by 12 lead Electrocardiogram. Data were recorded electronically and those with newly identified AF were followed up to examine management post diagnosis.
In total, 7262 subjects were screened and an irregular pulse was found in 916 (12.6%) of whom 735 (10.1%) had known AF and 55 (0.76%) had newly detected AF. Of these 55 patients with newly documented AF, 28 (50.9%) were women, 38 (69.1%) had hypertension and eight (14.5%) had a smoking history. Mean body mass index in subjects with newly documented AF was 28.9 kg/m(2)(SD 5.6) There was no significant difference in gender mix (P = 0.4), smoking history (P = 0.8) or alcohol history (P = 0.8) with the overall population. Fifty-one (92.7%) subjects had a CHA2DS2VaSC score ≥ 2 of whom 33 (64.7%) were eventually anticoagulated and nine (17.6%) commenced on Aspirin. The rate of newly identified patients in AF was lower than in previous reported key studies because of a higher rate of subjects with known AF.
Opportunistic AF screening in a rural environment identified a substantial number of new cases, although less than in previous screening studies.
机会性筛查是识别房颤（AF）患者的有效手段。先前关于机会性筛查的研究是在人口密度高的地区进行的，且是在新型口服抗凝药物出现之前。我们开展了一项研究，以确定在以农村为主、人口密度低的地区进行房颤筛查的可行性。
在6个多月的时间里，当地全科医生对65岁及以上的受试者进行筛查，通过桡动脉脉搏触诊，并由12导联心电图确认。数据以电子方式记录，对新确诊为房颤的患者进行随访，以检查诊断后的管理情况。
总共筛查了7262名受试者，发现916人（12.6%）脉搏不规则，其中735人（10.1%）已知患有房颤，55人（0.76%）新检测出房颤。在这55例新记录的房颤患者中，28例（50.9%）为女性，38例（69.1%）患有高血压，8例（14.5%）有吸烟史。新记录的房颤患者的平均体重指数为28.9kg/m²（标准差5.6）。在性别构成（P = 0.4）、吸烟史（P = 0.8）或饮酒史（P = 0.8）方面，与总体人群无显著差异。51例（92.7%）受试者的CHA2DS2VaSC评分≥2，其中33例（64.7%）最终接受了抗凝治疗，9例（17.6%）开始服用阿司匹林。由于已知患有房颤的受试者比例较高，新确诊的房颤患者比例低于先前报道的主要研究。
在农村环境中进行机会性房颤筛查发现了大量新病例，尽管比先前的筛查研究少。
