Pulse checks could prevent thousands of strokes

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The Daily Mail reports that, if doctors checked the pulse of every patient they see, this measure could “prevent 12,000 strokes a year”.

The aim of the pulse checks would be to pick up cases of atrial fibrillation, a common heart rhythm disorder that increases the risk of a stroke.

The figure comes from a report released by the Atrial Fibrillation Association (AFA) and Anticoagulation Europe (ACE), which warn that there is a “silent epidemic” of atrial fibrillation and that this will worsen in the UK as the population ages. The report also sets out a number of ways that might improve the diagnosis and treatment of atrial fibrillation, including campaigns to raise awareness, further training for GPs and improved access to heart monitoring when a case is suspected.

Atrial fibrillation is a heart rhythm disorder where the upper chambers of the heart (the atria) contract in a faster and shallower way than normal, causing an irregular heartbeat. While this is happening the heart is less effective at pumping blood around the body.

There are three different forms of atrial fibrillation, based on how long the fibrillation lasts:

The AFA/ACE report estimates that 1.5 million people in the UK have atrial fibrillation but that currently up to half of these cases remain undiagnosed.

Not all people with the condition will show symptoms of atrial fibrillation. In people who do have symptoms, these can include:

With atrial fibrillation you may also have an irregular pulse.

NICE recommends that people going to their doctor with any of the signs described above, or who have had a stroke or mini-stroke, should have their pulse checked manually to see if it’s irregular. People who have no symptoms may also have an irregular pulse detected just by chance, when visiting their doctor for another reason.

NICE suggest that an electrocardiogram (ECG) should be performed in all patients who have an irregular pulse and are suspected to have atrial fibrillation, even without symptoms.

Blood does not flow smoothly out of the heart during an episode of atrial fibrillation, and this increases the risk of blood clots forming. Because of this, people with atrial fibrillation are at an increased risk of having a stroke (where a blood clot lodges in the brain). Atrial fibrillation can also lead to heart failure.

The factors reported to increase the risk of stroke in people with atrial fibrillation include:

There are various ways of treating atrial fibrillation, depending on the form it takes and other factors. Possible treatments include drug treatment, electrical treatments and surgery. People with atrial fibrillation who also have other risk factors for stroke should also take an anticoagulant to reduce their risk.

The AFA and ACE recommend the following measures:

Screening is a process of identifying apparently healthy people who may be at an increased risk of a disease or condition. The screening process does not include testing people who already have symptoms.

The UK National Screening Committee (NSC) advises government ministers and the NHS on all aspects of screening and supports implementation of screening programmes. National screening programmes for healthy people can be expensive and potentially lead to an increase in investigations and treatments for people who might not necessarily have developed symptoms or problems. The committee regularly assesses the evidence about new screening programmes that could be offered, to determine whether they would do more good than harm at a reasonable cost.

Currently, the NSC’s recommendation is that routine screening for atrial fibrillation in adults should not be offered. This policy is being reviewed. This review involves identifying any relevant new evidence published since the policy was made and assessing whether this evidence suggests that the policy should be changed. The review began in January 2010 and is expected to be completed by March 2012.

The AFA and the ACE’s extensive report also calls for: