Atrial fibrillation: Difference between revisions

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==Diagnosis==
===Routine office evaluation===
A study of routine pulse checks or [[electrocardiograms]] during routine office visits, found that the annual rate of detection of atrial fibrillation in elderly patients improved from 1.04% to 1.63%.<ref name="pmid17673732">{{cite journal |author=Fitzmaurice DA, Hobbs FD, Jowett S, ''et al'' |title=Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial |journal= |volume= |issue= |pages= |year=2007 |pmid=17673732 |doi=10.1136/bmj.39280.660567.55}}</ref> This implies that the [[sensitivity (tests)|sensitivity]] of the routine examination is 64% (1.04/1.63).
===Electrocardiogram===
Regarding the accuracy of the [[electrocardiogram]]<ref name="pmid17604299">{{cite journal |author=Mant J, Fitzmaurice DA, Hobbs FD, ''et al'' |title=Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial |journal= |volume= |issue= |pages= |year=2007 |pmid=17604299 |doi=10.1136/bmj.39227.551713.AE}}</ref>:
*Interpreted by software:
**[[sensitivity (tests)|sensitivity]] = 83%
**[[specificity (tests)|specificity]] = 99%
* Interpreted by a [[primary care physician]]:
**[[sensitivity (tests)|sensitivity]] = 80%
**[[specificity (tests)|specificity]] = 92%
* Interpreted by a [[primary care physician]] with software:
**[[sensitivity (tests)|sensitivity]] = 92%
**[[specificity (tests)|specificity]] = 91%
==Prognosis==
==Prognosis==
===Risk of stroke===
===Risk of stroke===

Revision as of 09:31, 24 August 2007

Diagnosis

Routine office evaluation

A study of routine pulse checks or electrocardiograms during routine office visits, found that the annual rate of detection of atrial fibrillation in elderly patients improved from 1.04% to 1.63%.[1] This implies that the sensitivity of the routine examination is 64% (1.04/1.63).

Electrocardiogram

Regarding the accuracy of the electrocardiogram[2]:

Prognosis

Risk of stroke

The risk of stroke in a patient with atrial fibrillation can be predicted with the CHADS2 score.

Treatment

Anticoagulation

Anticoagulation can prevent recurrent stroke. Among patients with nonvalvular atrial fibrillation, anticoagulation can reduce stroke by 60% while antiplatelet agents can reduce stroke by 20%. [3]. However, a recent meta-analysis suggests harm from anti-coagulation started early after an embolic stroke.[4]

References

  1. ↑ Fitzmaurice DA, Hobbs FD, Jowett S, et al (2007). "Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial". DOI:10.1136/bmj.39280.660567.55. PMID 17673732. Research Blogging.
  2. ↑ Mant J, Fitzmaurice DA, Hobbs FD, et al (2007). "Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from screening for atrial fibrillation in the elderly (SAFE) trial". DOI:10.1136/bmj.39227.551713.AE. PMID 17604299. Research Blogging.
  3. ↑ Hart RG, Pearce LA, Aguilar MI (2007). "Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation". Ann. Intern. Med. 146 (12): 857-67. PMID 17577005. [e]
  4. ↑ Paciaroni M, Agnelli G, Micheli S, Caso V (2007). "Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials". Stroke 38 (2): 423-30. DOI:10.1161/01.STR.0000254600.92975.1f. PMID 17204681. Research Blogging. ACP JC synopsis
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