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General practitioners stress the need to screen for heart rhythm disorder

Here for the flu? Let me check your heart rhythm. An EU-backed survey sheds light on atrial fibrillation (A-fib) screening in daily clinical practice, and how important primary care physicians think it is.

Health

A survey of general practitioners (GPs) conducted by the EU-funded AFFECT-EU project has highlighted the need for A-fib screening to be included in flu vaccination and cancer screening programmes. A-fib is an often-undetected heart condition that causes an irregular and often abnormally fast heart rhythm, increasing the risk of stroke, heart failure and other heart-related complications. In Europe, more than 11 million people are estimated to have this condition – a figure that is expected to see a marked rise in the future due to the continent’s ageing population. The survey findings were presented at the 2022 meeting of the European Heart Rhythm Association (EHRA), a scientific congress of AFFECT-EU project partner European Society of Cardiology (ESC). “Our study indicates that few atrial fibrillation screening programmes are established in Europe, yet GPs strongly believe they are needed,” remarks PhD student and study author Paulien Vermunicht of the University of Antwerp, Belgium, in a press release published on the ESC website. As reported in the press release, an earlier AFFECT-EU study had shown that the most feasible approach was for primary care health professionals to screen for A-fib when patients came to the practice for any reason. Patients’ heart rhythms would be checked using compact, handheld single-lead electrocardiogram (ECG) devices. In the recent survey presented at the EHRA 2022 congress, GPs in Europe were asked to express their views on implementing this screening approach in daily clinical practice. The multiple choice survey included questions on current practice and perceptions of screening for different diseases, the feasibility of opportunistic single-lead ECG screening, barriers to implementing this type of screening and preferred solutions. From the 561 responses received, an estimated 87 % of GPs said that A-fib screening was currently not established in their region. “However, the need for standardised atrial fibrillation screening was rated as 82.3 on a scale from 0 to 100, which was almost as high as for colon (86.5) breast (86.8) and cervical (89.2) cancers,” the press release states. As for feasibility, as many as 87.2 % of the respondents reported having no single-lead ECG devices in their practice.

Barriers and solutions

Around 25 % of GPs said they faced no obstacles to starting A-fib screening. However, stumbling blocks reported by the remaining respondents included the need for more education before implementing A-fib screening (18.9 %), insufficient resources in their practice (18.7%) and concern about wrongly diagnosing A-fib (10.5). Roughly 25 % of GPs chose integrating A-fib screening into existing flu vaccination or cancer screening programmes as a solution. Another almost equally popular choice was identifying patients suitable for A-fib screening with the help of algorithms incorporated in primary care software systems. “The AFFECT-EU consortium has created an algorithm that identifies patients at risk of atrial fibrillation based on the information in their medical record,” observed Prof. Renate Schnabel of AFFECT-EU (DIGITAL, RISK-BASED SCREENING FOR ATRIAL FIBRILLATION IN THE EUROPEAN COMMUNITY) project coordinator University Medical Centre Hamburg-Eppendorf, Germany. “When the patient visits the practice for any reason, the primary care software system alerts GPs who can then perform ECG screening. This procedure is being tested in Germany and is a big step forward.” For more information, please see: AFFECT-EU project website

Keywords

AFFECT-EU, heart, atrial fibrillation, screening, heart rhythm, GP, general practitioner, ECG