Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London.
Br J Gen Pract. 2018 Jun;68(671):e388-e393. doi: 10.3399/bjgp18X696605.
Atrial fibrillation (AF) is an important and modifiable risk factor for stroke. Earlier identification may reduce stroke-related morbidity and mortality. Trial evidence shows that opportunistic pulse regularity checks in individuals aged ≥65 years increases detection of AF. However, this is not currently recommended by the National Screening Programme or implemented by most clinical commissioning groups (CCGs).
To evaluate the impact of a systematic programme to promote pulse regularity checks, the programme's uptake in general practice, and the prevalence of AF.
Retrospective analysis of electronic primary care patient records in three east London CCGs (City and Hackney, Newham, and Tower Hamlets) over 10 years.
Rates of pulse regularity checks and prevalence of AF in individuals aged ≥65 years were compared from the pre-intervention period, 2007-2011, to the post-intervention period, 2012-2017.
Across the three CCGs, rates of pulse regularity checks increased from a mean of 7.3% pre-intervention to 66.4% post-intervention, achieving 93.1% ( = 58 722) in the final year. Age-standardised prevalence of AF in individuals aged ≥65 years increased significantly from a pre-intervention mean of 61.4/1000 to a post-intervention mean of 64.5/1000. There was a significant increase in a post-intervention trend to a final-year mean of 67.3/1000: an improvement of 9.6% (5.9/1000) with 790 additional new cases identified.
Organisational alignment, standardised data entry, peer-performance dashboards, and financial incentives rapidly and generally increased opportunistic screening with pulse regularity checks. This was associated with a significant increase in detection and prevalence of AF and is of public health importance.
心房颤动（AF）是中风的一个重要且可改变的危险因素。早期发现可能会降低中风相关的发病率和死亡率。试验证据表明，对年龄≥65 岁的个体进行机会性脉搏规则检查可增加 AF 的检出率。然而，国家筛查计划或大多数临床委托组（CCG）目前并不推荐这种做法。
评估系统的脉搏规则检查促进计划的影响，该计划在一般实践中的采用情况，以及 AF 的患病率。
对东伦敦三个 CCG（City and Hackney、Newham 和 Tower Hamlets）的电子初级保健患者记录进行回顾性分析，时间跨度为 10 年。
比较≥65 岁个体在干预前（2007-2011 年）和干预后（2012-2017 年）的脉搏规则检查率和 AF 患病率。
在三个 CCG 中，脉搏规则检查率从干预前的平均 7.3%增加到干预后的 66.4%，最后一年达到 93.1%（=58722）。≥65 岁个体的 AF 患病率从干预前的平均 61.4/1000 显著增加到干预后的平均 64.5/1000。干预后呈上升趋势，最后一年的平均患病率为 67.3/1000：与干预前相比，增加了 9.6%（5.9/1000），新发现 790 例病例。
组织一致性、标准化数据录入、同行绩效仪表板和财务激励措施迅速且普遍增加了机会性脉搏规则检查。这与 AF 的检出率和患病率的显著增加有关，具有重要的公共卫生意义。
