Programme Progress

Launch of Report: Atrial Fibrillation screening in General Practice in Ireland

The National Stroke Programme published a study entitled 'Atrial Fibrillation Screening in General Practice in Ireland' in Croi House, Galway on Saturday Feb 6th 2016.

This is the first study of opportunistic Atrial Fibrillation Screening in General Practice where a choice of treatment options for patients diagnosed with AF were available. 7,262 patients over 65 years were screened in the six months 1st January to 30th June 2014.

Atrial fibrillation (AF) is a common cardiac rhythm disturbance and increases in prevalence with age particularly the population 65 years and over. Admission to hospital can be frequent and AF is associated with a five-fold increased risk of stroke, a three-fold risk of heart failure and two-fold increased risk of both dementia and mortality. In Ireland, the population 65 years and over is increasing by approximately 20,000 each year for the foreseeable future and as a result AF is a growing public health concern.

The Cardiovascular and Stroke policy 'Changing Cardiovascular Health' identified prevention of stroke in primary care as a priority for the Irish Health System. The policy noted that the detection and management of patients with AF were of particular relevance for the prevention of stroke. The HSE National Stroke Programme prioritised stroke prevention as a leading objective. An Atrial Fibrillation/Stroke Prevention Working Group was convened to implement a programme of opportunistic screening for AF in two geographic areas and to carry out a formal evaluation.

  • The prevalence of AF in the study population during the study was 10.9% or 220/1,000 over 65 years/year. This is higher than reported in other Irish populations - TILDA reported a prevalence rate of 5.3%.
  • There were fifty five new cases of AF detected, giving an incidence rate of 17/1,000 over 65 years/year. Forty-nine percent were male and the mean age was seventy-seven years.

The cardiovascular risk factor profile in the population screened was:

  •  Smoking: 8.9% with a significant difference between males (10.5%) and females (7.6%)
  •  Alcohol: 55% consumed alcohol and, of these patients, 81% consumed less than 14 units per week, consumption was significantly higher among males (64% versus 47%)
  •  The cardiovascular risk factor profile of the new AF cases was:
  •  BMI: Almost thirty-four percent were obese (BMI ≥ 30 Kg/m2) and
  •  69% of males and 81% of females were either overweight or obese.
  •  Diabetes: The prevalence of diabetes was 25%.
  •  Alcohol: 56% consumed alcohol and, of these patients, 77% consumed less than 14 units per week
  •  Smoking: 5.7% were current smokers and all were female.
  •  Blood pressure: 4% of patients had a systolic blood pressure reading of ≥150mmHg. Females had significantly higher average systolic blood pressure reading than males (132.9mmHg versus 123.7mmHg). 70% of patients had medical history of hypertension and 97% of these were prescribed some form of anti-hypertensive medication.

The study shows that 95% of patients with newly diagnosed AF were at high enough risk of stroke to be considered for anticoagulation therapy. The prescribing of oral anticoagulation was high, indicating a positive change in practice, and evenly distributed between warfarin and the new oral anticoagulant agents.

HTA of Mechanical Thrombectomy for Stroke

Irish Heart Foundation National Audit of Stroke Care