Our main research activities are to determine how best to screen for atrial fibrillation (AF) at scale, to prevent as many strokes as possible. We trialled this in pharmacies, showing we could detect silent and unrecognised AF in 15 out of 1,000 people screened, by using novel technology – a miniature ECG machine that attaches to the back of a smartphone – to obtain an initial diagnosis in 30 seconds.
We also ran some pilot studies in general practice, showing that practice nurses are ideally placed to screen older patients coming to see the doctor.
AF is the most common abnormal heart rhythm – it has been estimated that if a person reaches the age of 40, there is a one in four lifetime risk of developing AF.
AF disturbs the flow of blood inside the heart, leading to formation of clots that can break off and travel to the brain, blocking brain arteries and causing severe strokes. AF is responsible for one third of all strokes and is largely preventable by anticoagulant medications, which stop the clots from forming inside the heart in AF.
Unfortunately, AF is frequently ‘silent’, especially in older people who are at greater risk of stroke, and the first sign of AF is a severe stroke.
If screening for AF could be implemented widely in those aged 65 or older, and this could be coupled with greater prescription of anticoagulant therapy as advised in guidelines, then thousands of strokes could be avoided, not only in Australia but globally.
Lowres N, et al. Feasibility and cost effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study. Thromb Haemost 2014; 111: 1167-76.
Freedman B, et al. Asymptomatic atrial fibrillation. The case for screening to prevent stroke. JAMA 2015; 314: 1911-12.
Freedman B, et al. Stroke prevention in atrial fibrillation. Lancet 2016; 388: 806-17.
Freedman B, et al. Screening for atrial fibrillation: a report of the AF-SCREEN International Collaboration (white paper) Circulation 2017; 135: 1851-67.
Orchard J, et al. Atrial fibrillation: is there enough evidence to recommend opportunistic or systematic screening? Int J Epidemiol 2018; 47:1372-78.
Orchard J, et al. eHealth Tools to Provide Structured Assistance for Atrial Fibrillation Screening, Management, and Guideline-Recommended Therapy in Metropolitan General Practice: The AF-SMART Study. J Am Heart Assoc 2019; Jan 8; (1): e010959. doi: 10.1161/JAHA.118.010959.