1 / 8

Screening and diagnosis of AF and stratifying stroke risk

Screening and diagnosis of AF and stratifying stroke risk. AF can be symptomatic and asymptomatic. Cumulative incidence of asymptomatic AF recurrence >48 hours not detected by serial ECG recordings during follow-up (FU). 110. 20. 15. No of patients. 10. 5. Baseline. FU1. FU2. FU3.

armani
Télécharger la présentation

Screening and diagnosis of AF and stratifying stroke risk

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Screening and diagnosis of AF and stratifying stroke risk

  2. AF can be symptomatic and asymptomatic Cumulative incidence of asymptomatic AF recurrence >48 hours not detected by serial ECG recordings during follow-up (FU) 110 20 15 No of patients 10 5 Baseline FU1 FU2 FU3 FU4 FU5 FU6 FU7 FU8 FU9 FU10 FU11 FU12 FU13 1. Fusteret al, Circulation 2011; 2. Israel et al, J Am CollCardiol2004 • Typical symptoms of AF include palpitations, fatigue, chest pain, light headedness, dyspnoea, syncope1 • However, AF may be asymptomatic2 • Patients (n=110) with history of AF underwent ECG monitoring with implantable pacemaker for 19±11 months2 • 50 patients had AF episodes lasting >48 hours • 19 (38%) of these were asymptomatic, with no AF detected by serial ECG recordings

  3. The time course of AF A typical sequence of periods in AF First documented Silent Paroxysmal Persistent Long-standing persistent Permanent Cammet al, Eur Heart J 2010 AF typically progresses from short, rare episodes to longer and more frequent attacks Over time, many patients will go on to develop sustained forms of AF

  4. Guideline recommendations for the detection and diagnosis of AF 1. Fusteret al, Circulation 2011; 2. Cammet al,Eur Heart J 2010 ACCF/AHA/HRS 2011 guidelines1 A diagnosis of AF should be based on history and clinical examination and confirmed by ECG recording, sometimes in the form of bedside telemetry or ambulatory Holter recordings All patients with AF should have a transthoracic echocardiogram to identify valvular heart disease Blood tests of thyroid, renal and hepatic function should also be carried out when evaluating a patient with AF ESC 2010 guidelines2 An ECG recording is necessary to diagnose AF Any arrhythmia that has the ECG characteristics of AF and lasts sufficiently long for a 12-lead ECG to be recorded, or at least 30 seconds on a rhythm strip, should be considered as AF

  5. Characteristics of an ECG recording for a patient with AF Normal sinus rhythm R T Atrial fibrillation P 2 1 Q S Fuster et al, Circulation 2011; Camm et al,Eur Heart J 2010 • An ECG of a patient with AF is characterized by disorganized electrical activity: • Consistent P waves are replaced by rapid irregular waves • Irregular R–R intervals

  6. Systematic versus opportunistic screening: the SAFE study The UK Screening for AF in the Elderly (SAFE) study • Involved 50 primary care practices and almost 15,000 patients • Aims: To determine the most cost-effective AF screening method, and to assess the incidence and prevalence of AF in the study population (aged ≥65 years) • Patients assigned to three groups for 12 months: • Routine clinical care • Systematic screening: • Patients invited by letter to attend a screening clinic • Opportunistic screening: • Patients’ notes flagged to remind practice staff to record the pulse during routine consultation • Patients with an irregular pulse were invited to attend a further appointment, where pulse taking and an ECG were performed Hobbs et al, Health Technol Assess 2005

  7. Systematic versus opportunistic screening: the SAFE study Mean incidence (%) Hobbs et al, Health Technol Assess 2005 Both opportunistic and systematic screening identified more cases of AF than routine clinical care The incremental cost per additional case detected by opportunistic and systematic screening was £363 and £1787, respectively Pulse taking (to exclude patients without irregular pulses) reduces the number of ECGs performed, thus making opportunistic screening more cost-effective than systematic screening

  8. How can we achieve earlier diagnosis of AF? 1. http://www.aa-international.org; 2. Hobbs et al, Health Technol Assess 2005 • Public campaigns to increase awareness of: • The early signs of AF (e.g. irregular pulse) • ‘Know your pulse’ campaign (Arrhythmia Alliance)1 • Conditions that predispose to AF • Opportunistic screening in primary care (e.g. the SAFE study2) • Particularly in patients with other stroke risk factors such as: • Congestive heart failure, hypertension, age >75 years, diabetes mellitus, previous stroke/TIA

More Related