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From Citizendium, the Citizens' Compendium

Contents 1 Diagnosis 1.1 Routine office evaluation 1.2 Electrocardiogram 2 Prognosis 2.1 Risk of stroke 3 Treatment 3.1 Rate control versus rhythm control 3.2 Anticoagulation 4 References

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]:

• Interpreted by software:
  • sensitivity = 83%
  • specificity = 99%
• Interpreted by a primary care physician:
  • sensitivity = 80%
  • specificity = 92%
• Interpreted by a primary care physician with software:
  • sensitivity = 92%
  • specificity = 91%

Prognosis

Risk of stroke

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

Treatment

Rate control versus rhythm control

Among patients with heart failure, rhythm control was associated with slight, although statistically insignificant, increase in mortality.^[3]

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%. ^[4]. However, a recent meta-analysis suggests harm from anti-coagulation started early after an embolic stroke.^[5]

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.
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.
3. ↑ Roy D, Talajic M, Nattel S, et al (June 2008). "Rhythm control versus rate control for atrial fibrillation and heart failure". N. Engl. J. Med. 358 (25): 2667–77. DOI:10.1056/NEJMoa0708789. PMID 18565859.
4. ↑ 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.
5. ↑ 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. ACP JC synopsis