Researchers hope screening for heart condition could prevent strokes
Cambridge University researchers are leading the largest trial to date to find whether screening for an under-diagnosed heart condition could help prevent strokes.
Atrial fibrillation is an under-diagnosed heart condition which causes irregular heartbeat and increases the risk of having a stroke 5-fold and is associated with heart attacks and premature death from other causes.
AF affects up to one in 10 people over the age of 65 but does not necessarily cause symptoms. Many people who have AF are not aware they have it. In fact, 10 per cent of strokes occur in people unaware they have AF. However, treatment with medication can significantly lower the risk of stroke as well as lowering the risk of having a heart attack.
The researchers and consortium partners aim to discover if the number of strokes will be reduced when GP surgeries screen for AF in people aged 65 and over and then treat those who have it.
They will also work out whether the screening is good value for money for the NHS. The results will help the NHS decide whether to start a national screening programme for atrial fibrillation.
Ultimately 120,000 patients aged 65 and over in 300 general practices across England will take part in the research, which will be the largest ever randomised controlled trial (RCT) of screening for atrial fibrillation.
Randomised controlled trials or RCTs are used to test a specific drug, treatment or other intervention: researchers use RCTs to look at the differences between people randomly assigned to groups who get different treatments.
Practices taking part in the research will be randomly assigned to either ‘screening’ or ’non-screening’. Patients aged 65 and over in the screening practices will be invited to join the trial and to be screened for atrial fibrillation.
Researchers will then be able to compare the health of the patients in the ‘screening’ practices with that of patients in the ‘non-screening’ practices. Over the following five years they will measure whether the screening and the treatment that is offered makes a difference to people’s health and leads to a reduction in the number of strokes, heart attacks, and deaths in people who are screened.
The researchers have begun working with GPs and nurses in 12 GP practices around Cambridge, Peterborough, Norfolk and Hertfordshire to fine tune the screening process before embarking on the main trial.
Patients undergoing screening will use a handheld device to record their ECG. The device, which is small and easy to use, will be loaned to patients for use at home.
Some people have atrial fibrillation which comes and goes at different times, so this home screening technique will detect cases of intermittent atrial fibrillation that otherwise would be missed in a one-off test at a GP appointment.
Marie Corcoran, National Institute for Health Research nurse, is supporting GP practices taking part in the early phase of the study.
She said: “We are about to start recruitment of patients to take part in the study; 12 GP practices in the Eastern area will be involved in this first stage, including the one I am at today, Granta medical practices at the Sawston site in Cambridgeshire. The GPs are hoping that the project will be an effective way to improve their AF detection and treatment rates.
“The use of the device is simple to explain to patients, and overall we are excited to be paving the way for the start of the main trial – which will currently be the largest AF screening trial in the world.”
The AF study, which is called SAFER, is funded by the National Institute for Health Research. Learn more at: www.safer.phpc.cam.ac.uk/
• PHOTOGRAPH: National Institute for Health Research nurse, Marie Corcoran. Picture credit – Nick Saffell.