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. 2018 Jun;68(671):e388-e393.
doi: 10.3399/bjgp18X696605.

Opportunistic pulse checks in primary care to improve recognition of atrial fibrillation: a retrospective analysis of electronic patient records

James Cole  1 , Payam Torabi  1 , Isabel Dostal  1 , Kate Homer  1 , John Robson  1
Affiliations

Opportunistic pulse checks in primary care to improve recognition of atrial fibrillation: a retrospective analysis of electronic patient records

James Cole et al. Br J Gen Pract. 2018 Jun.

Abstract

Background: Atrial fibrillation (AF) is an important and modifiable risk factor for stroke. Earlier identification may reduce stroke-related morbidity and mortality. Trial evidence shows that opportunistic pulse regularity checks in individuals aged ≥65 years increases detection of AF. However, this is not currently recommended by the National Screening Programme or implemented by most clinical commissioning groups (CCGs).

Aim: To evaluate the impact of a systematic programme to promote pulse regularity checks, the programme's uptake in general practice, and the prevalence of AF.

Design and setting: Retrospective analysis of electronic primary care patient records in three east London CCGs (City and Hackney, Newham, and Tower Hamlets) over 10 years.

Method: Rates of pulse regularity checks and prevalence of AF in individuals aged ≥65 years were compared from the pre-intervention period, 2007-2011, to the post-intervention period, 2012-2017.

Results: Across the three CCGs, rates of pulse regularity checks increased from a mean of 7.3% pre-intervention to 66.4% post-intervention, achieving 93.1% (n = 58 722) in the final year. Age-standardised prevalence of AF in individuals aged ≥65 years increased significantly from a pre-intervention mean of 61.4/1000 to a post-intervention mean of 64.5/1000. There was a significant increase in a post-intervention trend to a final-year mean of 67.3/1000: an improvement of 9.6% (5.9/1000) with 790 additional new cases identified.

Conclusion: Organisational alignment, standardised data entry, peer-performance dashboards, and financial incentives rapidly and generally increased opportunistic screening with pulse regularity checks. This was associated with a significant increase in detection and prevalence of AF and is of public health importance.

Keywords: atrial fibrillation; pulse; screening.

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Figures

Figure 1.
Figure 1.
Proportion of patients aged ≥65 years with pulse check in the last 5 years by CCG. CCG = clinical commissioning group.
Figure 2.
Figure 2.
Prevalence of atrial fibrillation per 1000 people aged ≥65 years by CCG. CCG = clinical commissioning group.
See this image and copyright information in PMC

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