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GPs could screen for AF during flu clinics, researchers suggest



Digital screening for atrial fibrillation at influenza vaccination clinics may be a cost effective way for GPs to target at risk groups, say UK researchers. 

A study done in four GP practices in Kent over two flu seasons offered patients over the age of 65 a free heart rhythm check when they attended a flu vaccine clinic.

GP pharmacists were trained to carry out the screening which was done in more than 600 patients using with pulse and single lead ECG mobile device.

Reporting in PLoS Medicine, the team found a total prevalence of atrial fibrillation of 4.3%.

All those found to have atrial fibrillation qualified for anticoagulation and were more likely to be male (57.7%), to be older, and have a higher rate of co-morbidities including hypertension and diabetes.

Overall clinical pharmacists using the mobile device were able to detect 24 out of 26 possible atrial fibrillation diagnoses when compared with a cardiologist.

Using the digital technology there were fewer false positives than using pulse palpation alone (7.8% vs 2.6%).

The researchers also said that clinical pharmacists could potentially to treat and manage both the condition and the associated risk factors linked to other coexisting diseases and can provide patient education.

Study leader Dr Emma Veale from the Medway School of Pharmacy said the study showed that detecting atrial fibrillation using automated technology during flu vaccination appointments is a feasible approach.

‘Further studies are needed to investigate how to broaden AF screening to those at-risk who do not participate in the influenza vaccination and to explore the key barriers outlined by policymakers, which have delayed the adoption of a national AF screening programme.’

Currently the UK National Screening Committee does not recommend a screening programme for atrial fibrillation because it is not known if screening is more beneficial than the current approach and how effective treatment is for people diagnosed with the condition through screening.

Guidance published by NICE in 2019 found there is currently not enough evidence to recommend the routine adoption of single lead ECG devices for single time point atrial fibrillation testing in primary care and more research was needed.

READERS' COMMENTS [12]

Simon Gilbert 23 September, 2020 7:00 pm

Cost effective for who?

Beaker . 23 September, 2020 7:11 pm

Do these people not realise how bulk flu clinics work

Nick Hutchinson 23 September, 2020 8:48 pm

Did this in our flu clinic about 4 years ago , found 2 new AF patients out of about 400 patients- same process as suggested above .

Alan Gleave 23 September, 2020 10:15 pm

Recycled research.Remember this the first few time they said we were well placed to do this.A lot of water under the bridge since then.

Vinci Ho 24 September, 2020 7:25 am

Sigh!( I tend to use this word a lot lately , I wonder why 😈?):
(1) It is right to say picking up ‘irregularly irregular’ rhythm is straight forward and handy during a face to face contact in general practice. And indeed the ramifications of detecting such abnormality is far reaching especially for the diagnosis of AF and the subsequent preventive treatment(s) for stroke (2) I don’t know how old this study(the link quoted in the article is erroneous 👿) is and presumably , the actual study period was before Covid -19 . So then the common sense is : it was then , this is now against the backdrop of the most challenging seasonal flu campaign we have ever embraced under the restrictions of shortest contact and social distancing with our patients . Once again , time(of exposure) is not only one vital resource but also risk factor .
(3) Clearly , there is no currently official recommendation for AF screening and it would be out of touch with reality to consider any during this historic pandemic.
Academically , yes, research should be still encouraged but one has to be realistic. May be , just may, when the technology is even more advanced: for example , the patient’s heart rate and rhythm can be shown on my monitor screen while they are on a phone consultation with us .

David Jarvis 24 September, 2020 9:54 am

Not this year. Hard enough with PPE and increased numbers. Are they completely stupid?

Fergal Mccann 24 September, 2020 10:34 am

These people have never run a flu clinic

Doors propped open, sleeves up

Next!

Kevlar Cardie 24 September, 2020 12:53 pm

1 X broom.
1 X tube KY gel.

David Church 24 September, 2020 1:21 pm

Errr, … no we CAN’T : we have been told to not touch the patients, except with the needle, so feeling for pulses would be imposible!
Or do we get one of those heart-beat gun detectors demonstrated on NCIS-Los Angeles? If it is not fiction, will government be funding them?

Andi Williams 24 September, 2020 2:36 pm

was this during a covid crises using PPE restrictions one asks?

Patrufini Duffy 24 September, 2020 7:51 pm

Could’ve should’ve won’t…the workforce is not so naive.

Anne Hoffmann 24 September, 2020 7:59 pm

maybe we could weigh them and dip their urine as well as we so nothing else to do ..could not make this up ..really BS