Heart screening in older people could prevent strokes

11 May 2017
Dr Katrina Poppe
Dr Katrina Poppe

A University of Auckland academic is supporting calls for heart screening older people to detect the risk of future strokes.

Dr Katrina Poppe of the University’s School of Population Health, is a member of AF-SCREEN, an international collaboration pushing for national screening programmes for the common heart condition atrial fibrillation (AF) which can trigger strokes.

AF-SCREEN research published in today’s issue of Circulation, the journal of the American Heart Association, calls for screening for asymptomatic atrial fibrillation (AF) in people aged 65 and over. Detection of AF followed by appropriate preventive treatment with anticoagulant medications (blood thinners) could prevent many thousands of strokes worldwide each year.

The AF-SCREEN International Collaboration comprises over 130 cardiologists, neurologists, GPs, health economists, nurses, pharmacists and patient support organisations from 33 countries. The White Paper was co-authored by 60 AF-SCREEN members.

AF is a common abnormal heart rhythm which accounts for one in three strokes. This happens because the abnormal heart rhythm poses the risk of blood clots forming inside the heart. When clots break off they may travel to the brain, causing a stroke. 

About 10 percent of ischaemic strokes are caused by AF that is first detected at the time of stroke. Asymptomatic AF which underlies these strokes is not uncommon and can be easily detected by simply taking the pulse, or by handheld ECGs and other devices which provide a diagnosis in less than a minute.

“Strokes from AF are larger, more severe and harder to survive than other strokes,” says Dr Poppe.

“To be able to protect vulnerable people from ever experiencing one will spare them and their families a lot of heartache.”

Statistics from the World Heart Federation show 15 million people have a stroke each year, nearly six million die and another five million are left permanently disabled. In New Zealand, at least 7 people die from a stroke each day, and of the 57,000 people currently living with a stroke, half to two thirds are not independent in the activities of daily living.

“Widespread screening for asymptomatic atrial fibrillation in people aged 65 years and above could cost-effectively reduce strokes and their associated disability, and help save lives, however, this is not yet widely recommended in guidelines.” 

Professor Doughty, Heart Foundation Chair of Heart Health at the University of Auckland, says: “There is strong evidence for effective ways to reduce the risk of stroke for people with AF. As people may not have symptoms for some time despite having AF, early detection becomes important. The optimal way to detect AF for people in NZ still needs to be evaluated, and is the subject of several ongoing programmes of research.”

Screening has been shown to detect undiagnosed AF in one to three percent of people aged 65 to 75 years of age.

Given how easy it is to detect AF, AF-SCREEN 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 White Paper calls for governments worldwide to introduce screening for all older people, at age 65 or possibly older. The paper points out that any such programmes need to be appropriate for the local healthcare system, but could include programmes run through GPs, pharmacies or in the community, and could be carried out with pulse checking, a blood pressure monitor or, ideally, a handheld ECG device, the best tool for rapidly offering a firm AF diagnosis.

Further information about AF is available on the Heart Foundation website http://admin.heartfoundation.org.nz/atrial-fibrillation

Fast Facts on Atrial fibrillation, screening and treatment

  • Atrial fibrillation (AF) is responsible for one third of all strokes.
  • 27 per cent of AF-related strokes (amounting to 10% of all strokes) aren’t detected prior to stroke because AF is often asymptomatic (no apparent symptoms and unrecognised by the person with AF)
  •  AF-related strokes are more severe and cause greater disability than non-AF strokes
  •  Widespread screening for asymptomatic AF among people aged 65 years and over would be an important way to prevent strokes and the burden of stroke-related harm because AF-related strokes are largely preventable by treatment with oral anticoagulant drugs.
  •  Healthcare systems need to address optimal processes to screen for AF

AF-SCREEN International Collaboration website www.afscreen.org

The White Paper, Screening for Atrial Fibrillation, A Report of the AF-SCREEN International Collaboration, has 60 contributing authors.

Circulation May 9th 2017 issue 19; Vol 135.


 

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