Jaakkola Jussi, Virtanen Raine, Vasankari Tuija, Salminen Marika, Airaksinen K E Juhani
Heart Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Box 52, FIN-20521, Turku, PO, Finland.
Institute of Clinical Medicine, Family Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
BMC Geriatr. 2017 Sep 16;17(1):218. doi: 10.1186/s12877-017-0607-0.
Atrial fibrillation (AF) is often asymptomatic and undiagnosed until an ischaemic stroke occurs. An irregular pulse is a key manifestation of AF. We assessed whether pulse self-palpation is feasible in screening of AF.
Altogether 205 residents of Lieto municipality aged ≥75 years were randomized in 2012 to receive brief education on pulse palpation focusing on evaluating rhythm regularity. Self-detected pulse irregularity and new AF diagnoses were recorded, and the subjects' quality of life and use of health care services were assessed during a three-year follow-up.
The subjects' median age was 78.2 [3.8] years, and 89 (43.4%) were men. Overall, 139 (68%) subjects had initial good motivation/capability for regular palpation. At four months, 112 (80.6%) subjects with good and 26 (39.4%) with inadequate motivation/capability palpated their pulse daily. At 12 months, 120 (58.5%) and at 36 months, 69 (33.7%) subjects palpated their pulse at least weekly. During the intervention, 67 (32.7%) subjects reported pulse irregularity. New AF was found in 10 (4.9%) subjects, 7 (70%) of whom had reported pulse irregularity. Pulse irregularity independently predicted new AF, but only one (0.5%) subject with new AF sought undelayed medical attention due to pulse irregularity. Quality of life and number of outpatient clinic visits remained unchanged during follow-up.
Pulse palpation can be learned also by the elderly, but it is challenging to form a continuing habit. The low persistence of pulse self-palpation limits its value in the screening of AF, and strategies to promote persistence and research on alternative screening methods are needed.
http://www.ClinicalTrials.gov identifier: NCT01721005. The trial was registered retrospectively on October 26, 2012.
心房颤动（AF）通常无症状，直到发生缺血性卒中才被诊断出来。脉搏不规则是AF的一个关键表现。我们评估了自我触诊脉搏在AF筛查中是否可行。
2012年，共有205名年龄≥75岁的列托市居民被随机分组，接受关于脉搏触诊的简短教育，重点是评估节律的规律性。记录自我检测到的脉搏不规则情况和新诊断的AF病例，并在三年随访期间评估受试者的生活质量和医疗服务使用情况。
受试者的中位年龄为78.2[3.8]岁，89名（43.4%）为男性。总体而言，139名（68%）受试者最初有定期触诊的良好动机/能力。在四个月时，112名（80.6%）有良好动机/能力的受试者和26名（39.4%）动机/能力不足的受试者每天触诊脉搏。在12个月时，120名（58.5%），在36个月时，69名（33.7%）受试者至少每周触诊一次脉搏。在干预期间，67名（32.7%）受试者报告脉搏不规则。10名（4.9%）受试者被发现患有新发AF，其中7名（70%）报告了脉搏不规则。脉搏不规则独立预测新发AF，但只有1名（0.5%）新发AF受试者因脉搏不规则而及时寻求医疗关注。随访期间，生活质量和门诊就诊次数保持不变。
老年人也可以学会脉搏触诊，但养成持续的习惯具有挑战性。自我触诊脉搏的低持续性限制了其在AF筛查中的价值，需要采取促进持续性的策略并研究替代筛查方法。
http://www.ClinicalTrials.gov标识符：NCT01721005。该试验于2012年10月26日进行回顾性注册。
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