Detecting and Diagnosing Atrial Fibrillation (D2AF): study protocol for a cluster randomised controlled trial.
BACKGROUND
Atrial fibrillation is a common cause of stroke and other morbidity. Adequate treatment with anticoagulants reduces the risk of stroke by 60 %. Early detection and treatment of atrial fibrillation could prevent strokes. Atrial fibrillation is often asymptomatic and/or paroxysmal. Case-finding with pulse palpation is an effective screening method, but new methods for detecting atrial fibrillation have been developed. To detect paroxysmal atrial fibrillation ambulatory rhythm recording is needed. This study aims to determine the yield of case-finding for atrial fibrillation in primary care patients. In addition, it will determine the diagnostic accuracy of three different case-finding methods.


METHODS
In a multicenter cluster randomised controlled trial, we compare an enhanced protocol for case-finding of atrial fibrillation with usual care. We recruit 96 practices. We include primary care patients aged 65 years or older not diagnosed with atrial fibrillation. Within each practice, a cluster of 200 patients is randomly selected and marked. Practices are evenly randomised to intervention or control group. The allocation is not blinded. When a marked patient visits an intervention practice, the case-finding protocol starts, consisting of: pulse palpation, sphygmomanometer with automated atrial fibrillation detection and handheld single-lead electrocardiogram (ECG). All patients with at least 1 positive test and a random sample of patients with negative tests receive a 12-lead ECG. Patients without atrial fibrillation on the 12-lead ECG, undergo additional continuous Holter and use the handheld single-lead ECG at home for 2 weeks. Control practices provide care as usual. The study runs for 1 year in each cluster. The primary outcomes are the difference in detection rate of new AF between intervention and control practices and the accuracy of three index tests to diagnose AF. We are currently recruiting practices. The 'Detecting and Diagnosing Atrial Fibrillation' (D2AF) study will determine the yield of an intensive case-finding strategy and the diagnostic accuracy of three index tests to diagnose atrial fibrillation in a primary care setting.


BACKGROUND
Netherlands Trial Register: NTR4914 , registered on the 25 of November 2014.
Department of General Practice, Amsterdam Medical Center, J2-118, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. s.b.uittenbogaart@amc.uva.nl.
Steven B
SB
Uittenbogaart
Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. nicole.vangurp@maastrichtuniversity.nl.
Nicole
N
Verbiest-van Gurp
Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. petra.erkens@maastrichtuniversity.nl.
Petra M G
PM
Erkens
Department of General Practice, Amsterdam Medical Center, J2-118, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. w.a.lucassen@amc.uva.nl.
Wim A M
WA
Lucassen
Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. andre.knottnerus@maastrichtuniversity.nl.
J André
JA
Knottnerus
Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. bjorn.winkens@maastrichtuniversity.nl.
Bjorn
B
Winkens
Department of General Practice, Amsterdam Medical Center, J2-118, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. h.c.vanweert@amc.uva.nl.
Henk C P M
HC
van Weert
Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. jelle.stoffers@maastrichtuniversity.nl.
Henri E J H
HE
Stoffers
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology; D001795:Blood Pressure Determination; D002985:Clinical Protocols; D042241:Early Diagnosis; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D009426:Netherlands; D010173:Palpation; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011379:Prognosis; D011674:Pulse; D015203:Reproducibility of Results; D012107:Research Design; D019722:Sphygmomanometers; D013997:Time Factors