title: Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: A cluster-controlled clinical trial.
abstract: OBJECTIVE
  The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged≥65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated.
  
  
  METHODS
  This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the experimental group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the control group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation.
  
  
  RESULTS
  A total of 5,465 patients with a mean age of 75.61 years were recruited for the EG, and 1,525 patients with a mean age of 74.07 years were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3 and 15.0% of the patients in the EG and the CG, respectively (P<.001). A total of 164 new cases of atrial fibrillation were detected (2.3%), 1.1% in the EG and 6.7% in the CG (adjusted OR: 0.29; 95% CI 0.18-0.45).
  
  
  CONCLUSIONS
  Case finding for atrial fibrillation in patients aged≥65 years with symptoms or signs suggestive of atrial fibrillation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients.
  
  
  BACKGROUND
  The trial is registered in ClinicalTrials.gov (NCT01291953; February 8, 2011).
authors.affiliation: Servicio Andaluz de Salud, Córdoba, España.
authors.forename: Virginia
authors.initials: V
authors.lastname: González Blanco
authors.affiliation: Unidad Docente de Medicina Familiar y Comunitaria de Córdoba, Distrito Sanitario Córdoba y Guadalquivir, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Programa de Actividades Preventivas y Promoción de la Salud (PAPPS-semFYC), España. Electronic address: langel.perula.sspa@juntadeandalucia.es.
authors.forename: Luis Ángel
authors.initials: LÁ
authors.lastname: Pérula de Torres
authors.affiliation: Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Programa de Actividades Preventivas y Promoción de la Salud (PAPPS-semFYC), España; Centro de Salud/UGC Fuensanta, Servicio Andaluz de Salud , Córdoba, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Martín Rioboó
authors.affiliation: Centro de Salud Argentona, Consorci Sanitari del Maresme, Argentona, Barcelona, España.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Martínez Adell
authors.affiliation: Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Unidad de Gestión Clínica Guadiato, Consultorio de Villanueva del Rey, Servicio Andaluz de Salud, Villanueva del Rey, Córdoba, España.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Parras Rejano
authors.affiliation: Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Unidad de Gestión Clínica, Centro de Salud Cabra, Servicio Andaluz de Salud, Cabra, Córdoba, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: González Lama
authors.affiliation: Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Centro de Salud/UGC Fuensanta, Servicio Andaluz de Salud , Córdoba, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Ruiz Moruno
authors.affiliation: Centre d'Atenció Primària Vallcarca, CatSalut, Barcelona, España.
authors.forename: Remedios
authors.initials: R
authors.lastname: Martín Alvarez
authors.affiliation: Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Centro de Salud Villarrubia de Córdoba, Servicio Andaluz de Salud, Villarrubia de Córdoba, Córdoba, España.
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Fernández García
authors.affiliation: Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Servicio de Cardiología, Hospital Regional Universitario Reina Sofía, Servicio Andaluz de Salud, Córdoba, España.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Ruiz de Castroviejo
authors.affiliation: Unidad Docente de Medicina Familiar y Comunitaria de Córdoba, Distrito Sanitario Córdoba y Guadalquivir, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Unidad de Gestión Clínica, Centro de Salud Carlos Castilla del Pino, Servicio Andaluz de Salud, Córdoba, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Roldán Villalobos
authors.affiliation: Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Servicio Andaluz de Salud, Córdoba, España; Universidad Francisco de Vitoria, Madrid, España.
authors.forename: Roger
authors.initials: R
authors.lastname: Ruiz Moral
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis*; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015999:Multivariate Analysis; D010173:Palpation; D011320:Primary Health Care
keywords: Atrial fibrillation; Búsqueda de casos; Case finding; Cribado oportunista; Fibrilación auricular; Heart rhythm disorders; Opportunistic screening; Trastornos del ritmo cardiaco