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Screen for abnormal heart rhythm in older people to reduce stroke risk: white paper

Widespread screening for atrial fibrillation (AF), an irregular heart rhythm that can cause blood clots to form in the heart and travel to the brain, in people aged 65 years and over could reduce the risk of strokes and premature deaths, a collaboration of experts has said in a recent white paper.

University of Sydney and Heart Research Institute cardiology professor Ben Freedman said that while this could help save lives, it is not yet widely recommended in guidelines.

Freedman and colleagues from AF-SCREEN International Collaboration penned a report on the issue in Circulation, the journal of the American Heart Association.

The team said approximately 10 per cent of ischemic strokes are associated with AF are first diagnosed at the time of stroke. “Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation."

Sixty members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document for the report. After meeting in Rome to consider the draft paper, the team said the key points emphasise that screen-detected AF found at a single timepoint or by intermittent ECG recordings over two weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation.

Freedman and colleagues also published evidence that AF can be detected accurately in just 30 seconds via an ECG using a handheld device attached to an iPhone. Freedman said: “Given such easy ways to detect AF, and our demonstration of the poor outcomes that can be substantially modified by treatment, we believe there is a reasonable, cost-effective case to screen for this abnormal heart rhythm in older people in the community, as well as in the clinic".

The paper also said settings for screening must be linked to a pathway for appropriate diagnosis and management for screening to be effective.

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