Atrial fibrillation: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Routine office evaluation=== | ===Routine office evaluation=== | ||
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Revision as of 22:32, 20 November 2007
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
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%. [3]. However, a recent meta-analysis suggests harm from anti-coagulation started early after an embolic stroke.[4]
References
- ↑ 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. Research Blogging.
- ↑ 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. Research Blogging.
- ↑ 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. [e]
- ↑ 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. Research Blogging. ACP JC synopsis