Identify patients with Atrial Fibrillation

Thousands of people with Atrial Fibrillation are not being diagnosed because doctors are pushed for time and are not carrying out simple pulse checks, says Professor Camm, professor of clinical cardiology based at St George’s, University of London, and an international renowned expert in atrial fibrillation. He is also President of Arrhythmia Alliance and a Trustee of AF Association.

“This year, to mark the AF Association Global AF Aware Week, the trustees at the charity AF Association are keen to get across the message that doctors and healthcare professionals should aim to identify the many thousands of people who have atrial fibrillation but don’t yet have a diagnosis.

We believe that around a third of people with AF fall into this category because they don’t have the typical symptoms of noticeable rapid irregular heart rhythm, chest pain and anxiety. Instead, they may simply feel tired and a bit breathless on exertion. Because most people with AF are past retirement age, they may put it down to the normal changes associated with ageing.

In fact, they have a treatable condition, which if left alone, could lead to increased risk of AF-related stroke, heart failure, sudden death, cognitive dysfunction and even dementia. These people are often in an out of hospital with a variety of complaints, which usually means that their underlying condition is found.

Detection is straightforward. A simple pulse check can alert a doctor or healthcare worker that there may be an arrhythmia (heart rhythm disorder) issue and the diagnosis can be confirmed by an ECG.

In our opinion, GPs who are working in the community, are in the ideal place to carry out pulse checks on their older patients and check that they are not suffering from asymptomatic AF. The problem is that even a minute or two is a lot to take out of a typical six minute appointment with a GP, so it often doesn’t get done, even though there are now financial incentives for GP to detect AF and prescribe anticoagulation therapy to reduce their risk of AF-related stroke.

Also some GPs retain a rather dated attitude that AF in older people is not really a major issue. This stems from the fact that doctors who trained before the 1990s, were taught that AF was a normal part of ageing and only elevated stroke risk. In fact, we now know that it has a wide-ranging effect on health and quality of life. Over the last decade, studies have emerged which found that dementia is much more common in people with AF.

In the future, it may be that the UK adopts a screening programme for older people. This is likely to happen soon in other European countries including Sweden and Norway but it is still some way off here in the UK. The National Screening Council believes that there isn’t enough data yet to show that screening for AF is cost-effective in all older people, but every step in the process has already demonstrated that screening is very likely to reduce AF-related strokes and save lives. There are now plans to gather more of these all-important data, but it may take some years.

In the meantime, individual GPs and healthcare workers can simply take the decision to check for themselves, especially if patients are complaining about tiredness and breathlessness. Once someone has been diagnosed, the patient should receive anticoagulation therapy to reduce the risk of AF-related stroke by 80 per cent. Treatment to correct the arrhythmia include procedures that can correct the electrical abnormality in the heart, using ablation to isolate the triggers which are causing the atrial fibrillation in the first place. These procedures can be done in out-patient departments and are well tolerated by older people.”

Arrhythmia Alliance and the AF Association runs various education outreach workshops which are open to GPs and healthcare professionals to raise awareness about the Detect, Protect and Correct campaign as well as Know Your Pulse events.