GPs urged to check patients' pulse in bid to cut strokes

Tuesday, May 22, 2018

Thousands of strokes could be prevented if GPs check the pulse rate of elderly patients, a new study suggests.

Encouraging GPs to check the pulse rate of patients over 85 could lead to increased detection of an irregular heart beat, also known as atrial fibrillation (AF).

People with atrial fibrillation have a significantly higher risk of stroke, but if they have been diagnosed then they can be given medication to control their heart rate and reduce the risk.

But the condition often has no symptoms, and there is no national screening programme to detect AF.

The condition - which can be detected through pulse regularity checks - is estimated to affect around a million people across the UK - with more cases among the elderly.

A new study, published in the British Journal of General Practice, examined whether giving GPs prompts to check the pulse rate of elderly patients might improve detection rates for AF.

Researchers from Bart's and the London School of Medicine compared rates of atrial fibrillation before and after the introduction of a system which prompted GPs to check pulse regularity every five years among those age over 65 and annually for those with certain conditions.

GPs in three areas of London were given prompts when accessing patient records as well as GP practice performance on their rates of "opportunistic screening" and financial incentives.

Researchers noted a large increase in the proportion of patients over the age of 65 given pulse regularity checks from an average of 7.3% in the "pre-intervention period" - 2007 to 2011 - to an average of 66.4% in the five-year period after the system was put in place - 2012 to 2017.

In the final year of the study, this rose to 93% of eligible patients being checked.

Before the "opportunistic screening" prompts were introduced, the average number of annual AF cases identified in the three areas of London was 3,457.

This rose to 3,919 after the prompts were put in palace - an annual average increase of 462.

In the final year of the study, the prevalence of identified cases of AF had increased by almost 10%, researchers found.

As a result, more may have been put on anticoagulant medicine which helps prevent strokes.

The authors estimated that across Hackney, Tower Hamlets and London, where the study took place, at least 28 strokes were prevented during the study period.

If extrapolated across the whole of England, this could lead to 2,000 fewer strokes, they said.

"The estimated stroke reduction of more than 2,000 cases over the 209 CCGs in England is of public health importance," the authors wrote.

"Opportunistic pulse regularity checks can be rapidly and widely adopted in primary care. This is associated with an increase in the detection of new AF cases, management of which is likely to have an impact on the public health importance of stroke reduction."