Affiliated to research
Screening for atrial fibrillation and treatment with anticoagulant to prevent stroke
Supervisors: Prof Mårten Rosenqvist, Docent Holger Theobald, Docent Faris Al-Khalili
Atrial Fibrillation (AF) is the most common chronic cardiac arrhythmias. It is a frequent source of cardiac embolism in patients with ischemic stroke unless treated with anticoagulants. Ischemic stroke in association with AF is often fatal. Quality of life and physical capacity is reduced in patients with AF. AF can cause suffering through palpitation, shortness of breath and recurrent syncope. LV function often reduced. In addition, cognitive dysfunction including vascular dementia may be related to AF. AF may be asymptomatic and therefore undiagnosed. It is common for asymptomatic AF to be detected by chance or when a stroke has already occurred. AF usually goes from short, rare, to longer and more frequent attacks2. Intermittent asymptomatic AF is significantly associated with progression to permanent AF. Screening of risk groups for FF so that per oral anticoagulation treatment on AF indication can be given reduces the stroke incidence of those under investigation, thereby reducing the risk of thromboembolism, dementia and mortality. People over the age of 65 should be screened for AF, say stroke specialists. Silent AF screening may be appropriate in risk populations but little is known about the utility and cost effectiveness of primary care screening. Screening only in hospitals to find AF can underestimate the presence of AF at the same time as overestimation of comorbidity and thromboembolic risk may occur. Short-term ECG registration for longer periods of time may be a more sensitive tool, compared to short continuous ECG recordings, for detection of FF episodes. Short-term ECG, with Zenicor inch ECG to detect silent AF shows a sensitivity of 96% and specificity of 92%.
To improve the treatment of patients with AF by identifying patients with asymptomatic AF in the primary care, initate appropriate anticoagulantant therapy to prevent future stroke and initiate early treatment of AF to reduce the progression of heart disease.
1-What is the real prevalence of AF in the examined age group and their characteristics?
2-To which extent is possible to increase the use of oral anticoagulants to persons with AF in the primary health care?
Evaluation the role of NT-proBNP level in AF screening
Is screening for AF in the primary care in the examined group cost-effective?
1-To study the benifit of AF screening using intermittent thumb-ECG over 2 weeks in an unselected primary health care seeking population 65 years or over, compared with rest-ECG screening method.
2-To evaluate the value of pulse-takeing as self-diagnosis where individuals control their own pulse for defined period of time to find AF compared to "simultaneous" ECG registration.