Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht.
Department of Cardiology, Martini Hospital Groningen; assistant professor, Department of Cardiology, University Medical Center Groningen, Groningen.
Br J Gen Pract. 2020 May 28;70(695):e427-e433. doi: 10.3399/bjgp20X708161. Print 2020 Jun.
Atrial fibrillation (AF) increases the risk of stroke, heart failure, and all-cause mortality. AF may be asymptomatic and therefore remain undiagnosed. Devices such as single-lead electrocardiographs (ECGs) may help GPs to diagnose AF.
To investigate the yield of opportunistic screening for AF in usual primary care using a single-lead ECG device.
A clustered, randomised controlled trial among patients aged ≥65 years with no recorded AF status in the Netherlands from October 2014 to March 2016.
Fifteen intervention general practices used a single-lead ECG device at their discretion and 16 control practices offered usual care. The follow-up period was 1 year, and the primary outcome was the proportion of newly diagnosed cases of AF.
In total, 17 107 older people with no recorded AF status were eligible to participate in the study. In the intervention arm, 10.7% of eligible patients ( = 919) were screened over the duration of the study year. The rate of newly diagnosed AF was similar in the intervention and control practices (1.43% versus 1.37%, = 0.73). Screened patients were more likely to have comorbidities, such as hypertension (60.0% versus 48.7%), type 2 diabetes (24.3% versus 18.6%), and chronic obstructive pulmonary disease (11.3% versus 7.4%), than eligible patients not screened in the intervention arm. Among patients with newly diagnosed AF in intervention practices, 27% were detected by screening, 23% by usual primary care, and 50% by a medical specialist or after stroke/transient ischaemic attack.
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.
心房颤动（AF）会增加中风、心力衰竭和全因死亡率的风险。AF 可能是无症状的，因此未被诊断。单导联心电图（ECG）等设备可以帮助全科医生诊断 AF。
使用单导联 ECG 设备调查常规初级保健中 AF 的机会性筛查的效果。
这是一项 2014 年 10 月至 2016 年 3 月期间在荷兰年龄≥65 岁且无记录 AF 状态的患者中进行的聚类、随机对照试验。
15 个干预全科医生自行使用单导联 ECG 设备，16 个对照医生提供常规护理。随访期为 1 年，主要结局是新诊断 AF 病例的比例。
共有 17107 名无记录 AF 状态的老年人符合研究条件。在干预组中，919 名符合条件的患者中有 10.7%（=919）在研究年期间接受了筛查。干预组和对照组的新诊断 AF 发生率相似（1.43%与 1.37%，=0.73）。接受筛查的患者比干预组中未接受筛查的符合条件的患者更有可能患有合并症，如高血压（60.0%与 48.7%）、2 型糖尿病（24.3%与 18.6%）和慢性阻塞性肺疾病（11.3%与 7.4%）。在干预组中诊断为新的 AF 的患者中，27%是通过筛查发现的，23%是通过常规初级保健发现的，50%是通过医疗专家或中风/短暂性脑缺血发作发现的。
在社区中，与常规护理相比，GP 自行决定使用单导联 ECG 进行机会性筛查并未导致≥65 岁患者中新发现的 AF 病例数量增加。为了在未来的研究中提高参与率，需要更严格的筛查方法。
