Atrial fibrillation (AF) is a condition in which an irregular beating of the heart leads to a five times increased risk of having a stroke. This risk can be reduced by offering blood thinning medication. Often patients do not know that they have AF. AF can be detected when a doctor or nurse checks the patients pulse and finds an irregular heartbeat, which they can then confirm by arranging a confirmatory diagnostic test called an electrocardiogram (ECG) which is a tracing of the heart rhythm. AF is more common as people get older. For some years general practitioners (GPs) in parts of the country have been offering a pulse check when patients over 65 receive their annual flu vaccination. This study aims to explore if checking the pulse in this way is effective at finding AF, if patients who have AF found are offered blood thinning medication, and if this prevents stroke and death in these patients.
Beginning in 2008 with a number of locally enhanced service (LES) schemes some GP surgeries have been offering pulse checks at the time of flu vaccination to detect asymptomatic AF. Its presence leads to a fivefold increase in the risk of stroke, a risk that can be reduced with the use of anticoagulant medication. In this project we aim to investigate three linked aims. Firstly, whether the practice of checking a pulse with a flu vaccination increases the incidence of detected AF and in those with detected AF whether there is any difference in the incidence of stroke between those who were pulse checked with flu vaccination and those who were detected otherwise. Secondly whether patients with newly detected AF are offered anticoagulation and whether the rates of anticoagulation differ between the pulse checked and detected otherwise groups. Thirdly we will investigate whether there is a reduction in the proportion of the pulse checked group who experience a stroke or death. The first two aims will be descriptive in nature, the third will be investigated with a survival analysis, both unadjusted and adjusted for Age, sex, practice level IMD score and multi-morbidity score.
Incidence of new AF diagnosis; Incidence of anticoagulation after diagnosis of AF; Reduction in incidence of new stroke; Reduction in all-cause mortality.
Jenny Lund - Chief Investigator - University of Cambridge
Jenny Lund - Corresponding Applicant - University of Cambridge
Catherine Saunders - Collaborator - University of Cambridge
Catherine Saunders - Collaborator - University of Cambridge
Duncan Edwards - Collaborator - University of Cambridge
Jonathan Mant - Collaborator - University of Cambridge
Silvia (Silva) Mendonca - Collaborator - University of Cambridge
Practice Level Index of Multiple Deprivation