Diagnosis atrial fibrillation: Keeping your pulse on check

Atrial fibrillation (A-fib) is still discovered in many patients by chance or only after a stroke. Experts at the ESC 2018, therefore, urged once again that risk patients be screened more regularly for A-fib. After all, diagnosis is an important starting point for reducing the risk of stroke.

An undetected and untreated A-fib is a chronic and progressive disease - early diagnosis and treatment are therefore very important.

Atrial fibrillation (A-fib) is still discovered in many patients by chance or only after a stroke. Experts at the ESC 2018, therefore, urged once again that risk patients be screened more regularly for A-fib. After all, diagnosis is an important starting point for reducing the risk of stroke.

Screening leads to the diagnosis of patients with A-fib. The risk of stroke can then be determined and, if necessary, anticoagulant therapy can be initiated to reduce the risk. The experts discussed at the ESC 2018 in Munich how easy such screening can already be implemented and how the stroke risk of A-fib patients can be safely stratified.

Diagnosis of the A-fib according to guidelines and risk stratification

The diagnosis of A-fib is based on established ECG criteria. An A-fib episode is therefore at least 30 seconds long. If it is shorter than 30 seconds, the A-fib must recur throughout the ECG recording. 

Depending on the resistance of the A-fib, it is classified according to the 4-P classification:

Since the classification is not rigid, but the A-fib also behaves progressively over time, early treatment is indicated to reduce the risk of stroke. Studies show that the risk of thromboembolic events increases with the disease burden of A-fib, i.e. the frequency of episodes. Patients with the highest A-fib loads, for example, have a 3-fold higher risk if they do not receive anticoagulant therapy.

The risk of stroke for men and women with A-fib, for example, is determined using the CHA2-DS2-VASc. This results in the corresponding risk values for the following patient parameters:

According to the ESC guideline, this results in a need for anticoagulation for risk values ≥ 2 (for men) and ≥ 3 (for women) (recommendation level 1 A).

A-fib screening: first pulse, then ECG

Ischemic strokes are highly associated with A-fib and therefore, assuming the patient's A-fib has been diagnosed, are largely preventable. Up to 9% of stroke patients still know nothing about their A-fib before this event. But A-fib screening can be so simple.

It is sufficient to first feel the pulse with every patient contact. Studies have shown that A-fib suspicion has already been confirmed in about 1.4 % of people over 65 years of age. In order to diagnose an A-fib according to the guidelines, an ECG recording is required; this is also possible today via wearables or apps, but should always be checked by a doctor.

Conclusions

Atrial fibrillation is one of the main risk factors for stroke. Too many patients are still diagnosed by chance or only after an event has occurred. As A-fib is a progressive disease, early diagnosis and treatment are very important.

Especially for patients at the age of ≥ 65 years, it is recommended to palpate the pulse at least at every doctor-patient contact in the practice at the beginning. Those patients who already show noticeable irregularities in the sense of an A-fib are in need of therapy in any case. The diagnosis of A-fib and the clarification of suspicion of smaller A-fib episodes must always be based on an ECG according to the ESC guidelines.

Source:
"Spectrum of non-valvular atrial fibrillation: the burden of disease." (Organizer: Bristol-Myers Squibb and Pfizer Alliance), 27.08.2018, ESC Munich

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