Tag Archives: screening

Introduction The diagnosis of atrial fibrillation (AF) is made from an electrocardiogram (ECG) showing AF lasting for at least 30 seconds.1 The ECG characteristics of AF are irregularly irregular R–R intervals (where atrioventricular conduction is not impaired), absence of distinct repeating P-waves, and irregular atrial activations.1 AF is the most common sustained arrhythmia in the general population, with an estimated prevalence worldwide of 2% to 4%,2 and this is expected to increase two- to three-fold by 2030.3 In the UK, approximately 1.2 million individuals (1.8% of the populace) have been identified and diagnosed with AF.4,5 AF is a

Introduction There is an increasing prevalence of atrial fibrillation (AF) worldwide, with a one-in-three lifetime risk of developing AF over the age of 40 years.1 AF is a leading cause of stroke, and stroke risk is increased further in the presence of diabetes.2 Diabetes has been recognised as a risk factor for AF and, therefore, targeted screening for AF in such groups has been explored in combination with comorbid risk factors.2 There are yet to be universally accepted recommendations for AF screening. The European Society of Cardiology (ESC) recommend opportunistic screening in people >65 years and consideration of systematic screening

Introduction Prevalence of atrial fibrillation (AF) and diabetes is increasing worldwide.1,2 AF is a common heart rhythm irregularity and prevalence increases with age. People with AF are up to seven times more likely to have a stroke than the general population,1 with risk increased further in the presence of diabetes.3 AF may exhibit no symptoms and go undiagnosed until patients present with sequelae, such as stroke or heart failure. Stroke secondary to AF is often avoidable with thromboprophylaxis and early identification could lead to stroke prevention. Diabetes mellitus is a major risk factor for cardiovascular disease,4 and frequency of

Relationship between diabetes and AF Mass screening of AF in the STROKESTOP study2 discovered diabetes, heart failure and previous stroke/transient ischaemic attack (TIA) to be the strongest predictors for AF in multi-variate analysis. This confirms findings from the historical Framingham study, where diabetes conferred a 1.4-fold increased risk of stroke in men and a 1.6-fold increased risk in women.3 A recent review of the evidence from AF screening studies in those with perceived high risks, has demonstrated the prevalence of AF in people with diabetes ranges from 2.9%4 to 18.5%.2 Chan and Choy’s study (2016)5 did not find diabetes to be

Introduction Heart failure and valve disease are common. The population prevalence of each is 2–3% and this rises to more than 10% aged ≥75 years.1,2 Echocardiography is a key diagnostic investigation but it is a relatively scarce resource and is also underutilised.3 It has been suggested that access can be improved by targeting high-risk individuals using limited ‘point-of-care’ studies also called ‘quick-scans’.4 There has been an increase in the application of ‘quick-scans’ with the development of hand-held machines, which allow near-patient testing in the community or on ward-rounds, in clinics or in emergency departments.

Introduction People with atrial fibrillation (AF) are five times more likely to have a stroke.1 AF is an increasing problem as our population gets older.2 It is, therefore, important to be able to identify this condition as early as possible, when intervention with anticoagulation can prevent stroke, as is recommended by the National Institute for Health and Care Excellence (NICE), in most cases.3 Several studies have attempted to identify the most effective way of screening for, or case-finding, AF.4-7 The gold standard for diagnosis of AF is a 12-lead electrocardiogram (ECG). However, the 12-lead ECG is an impractical diagnostic tool for a

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Introduction Screening has been proposed as a method to detect patients with undiagnosed atrial fibrillation (AF) as it is a dangerous, prevalent condition that may be easily diagnosed with a simple low-cost test, an electrocardiogram (ECG), and the risk of serious sequelae such as ischaemic stroke can be effectively reduced with anticoagulation.1 Hence, it fulfils the Wilson Jungner criteria for a screening programme.2 The potential benefits of AF screening are far reaching, as reducing stroke prevalence has massive implications for both patients and health services in the UK, where stroke consumes approximately 5% of total National Health S

Introduction The implantable cardioverter defibrillator (ICD) implant rate within the UK remains significantly lower than that across Europe; furthermore, there is marked inequity in access to ICD implant between regions within the UK.1 The need for an ICD is self-evident in secondary prevention patients successfully resuscitated from ventricular tachycardia (VT) or ventricular fibrillation (VF). Intuitively, therefore, it would seem most likely that underperformance and inequity of access in the UK resides chiefly within the primary prevention patient group. A number of international randomised-controlled trials have identified patient subgr

Introduction The UK government’s recent commitment to aneurysm screening and the potential for funding this, will undoubtedly lead to increased interest in the organisation of new screening programmes by different trusts. In April 2007, the UK National Screening committee – AAA Screening Working Group published a draft for Standard Operating Procedures For An Abdominal Aortic Aneurysm (AAA) Screening Programme.1 The recommendations for population selection offer a single scan for males in the year they reach 65 years of age and also for males over 65 on request. Females, males under 65, those receiving previous AAA surgery, patients with