The detection and diagnosis of atrial fibrillation in Dutch general practice

Atrial fibrillation (AF) is a heart disease characterised by an irregular heart rhythm and that can present asymptomatically. AF can lead to complications, mainly stroke and heart failure. If patients with (silent) AF receive a timely diagnosis and are started on oral anticoagulants, this may prevent strokes.
This thesis describes the results of the Diagnosing and Detecting Atrial Fibrillation (D2AF) trial, a multicenter cluster randomised controlled trial set in primary care. It investigated whether opportunistic screening increases detection of AF as compared to usual care. The intervention consisted of inviting patients visiting the general practitioner (GP) for testing using pulse palpation and measurements with two devices with an AF-detection algorithm – an electronic blood pressure monitor and a single lead electrocardiogram.
The main finding was that opportunistic screening for AF did not improve the detection rate of AF (adjusted odds ratio 1.06 (95% confidence interval: 0.84–1.35)). In 0.7% of the screened patients, the protocol detected AF.
All methods were suitable for screening purposes, however using pulse palpation would lead to more false positive tests. GPs and nurses using the methods, found all three methods easy to use and suitable for implementation in general practices.
The thesis contains a systematic review demonstrating that there was no clear relation between a higher AF burden are at higher risk of stroke.
In conclusion, detection of AF during usual care by GPs in the Netherlands is as effective as screening. Future studies should focus on selecting high risk patients and using prolonged monitoring.