Screening of older patients for atrial fibrillation in general practice: Current evidence and its implications for future practice

Background: Individuals with atrial fibrillation (AF) face a fivefold increased risk of ischaemic stroke compared with those without the condition. Recent studies suggest that individuals with asymptomatic AF also face an increased risk of ischaemic stroke, but their condition is often not recognized and diagnosed until an ischaemic stroke event has occurred. Identification of individuals with undiagnosed AF at increased risk for stroke is critical in promoting optimal intervention with anticoagulants. Objectives: In this narrative review, we consider the benefits and limitations of various proposed screening strategies, whether single or multiple time-points, in addition to devices for implementation in the primary care setting. Outcomes: Opportunistic screening via pulse palpation with subsequent referral for 12-lead electrocardiogram testing has been shown to cost-effectively identify individuals with asymptomatic AF. Some handheld devices suitable for use in primary care settings are now available and may facilitate screening of large cohorts of individuals considered to be at increased risk of AF, such as those aged ≥65 years or those diagnosed with or undergoing monitoring for hypertension. Conclusions: It was determined that improved detection and diagnosis of AF, combined with appropriate anticoagulation strategies, will be crucial for improving stroke prevention and reducing its associated social and economic costs.