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Systematic screening for atrial fibrillation ‘better than routine GP practice’

Systematic screening in GP practices for atrial fibrillation could identify more people with the disease than routine practice, according to a gold-standard review.

The study
Cochrane Collaboration researchers analysed all randomised controlled trials that looked at systematic screening for atrial fibrillation in primary care. One cluster UK randomised controlled trial met the criteria for the review, which compared systematic screening of all patients aged 65 or older, opportunistic screening with pulse palpation in all patients aged 65 or older presenting at GP surgeries, to routine practice where new cases of atrial fibrillation were identified on clinical presentation. The study included 25 general practices and 15,000 patients.

The findings
Systematic and opportunistic screening identified more new cases than routine practice, with odds ratios of 1.57 and 1.58, respectively. There were no significant differences between the two screening interventions with regard to number of new cases detected. The number of cases needed to screen to detect one additional new case compared to routine practice was 172 for systematic screening and 167 for opportunistic screening. The researchers found a higher rate of uptake of systematic screening compared to opportunistic screening in both men and women, but systematic screening was more costly, with an incremental cost per additional case detected of £1,514 versus £337 for opportunistic screening.

What does this study mean for GPs?
The authors concluded: ‘Systematic and opportunistic screening for atrial fibrillation increase the rate of detection of new cases compared with routine practice. While both approaches have a comparable effect on the overall atrial fibrillation diagnosis rate, the cost of systematic screening is significantly more than that of opportunistic screening from the perspective of the health service provider. The lack of studies investigating the effect of screening in other health systems and younger age groups means that caution needs to be exercised in relation to the transferability of these results beyond the setting and population in which the included study was conducted.’

 Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD009586. DOI: 10.1002/14651858.CD009586.pub2.