荷兰阿姆斯特丹大学Steven B Uittenbogaart团队比较了机会性筛查与常规护理在初级保健中对心房颤动的检出率差异。2020年9月16日，《英国医学杂志》发表了该成果。

为了探讨在初级保健中进行机会性筛查是否比常规保健可增加房颤的检出率，2015年9月至2018年8月，研究组在荷兰进行了一项整群随机对照试验，共包括47项意图筛查和49项常规护理初级保健实践。

每项实践随机选择200名年龄在65岁以上、无房颤史的患者。意图筛查组中有9218例符合筛查条件的患者，其中55.0％为女性，平均年龄为75.2岁。常规护理组中有9526例患者，其中54.3％为女性，平均年龄为75.0岁。

机会性筛查包括三个指标检测：脉搏触诊、电子血压测量和手持式单导心电图设备心电图（ECG）。若至少一项指标为阳性，则进行12导联心电图检测，同时在三项指标均为阴性的患者中抽取部分（10％）进行。若12导联心电图未显示房颤，则邀请患者通过用Holter心电图仪连续监测两周来进行更多筛查。

研究组在意图筛查实践中完成了对8874例患者的随访，在常规护理实践中完成了对9102例患者的随访。意图筛查组中新诊断为房颤的患者有144例（1.62％），常规护理组有139例（1.53％），校正比值比为1.06。

在意图筛查组的9218名合格患者中，有4106名（44.5％）参加了12导联心电图筛查方案，新诊断出26例房颤患者（0.63%）。在266名继续进行Holter监测的患者中，又新诊断出4例房颤。

研究结果表明，对于65岁以上的初级保健者，进行房颤机会性筛查并不能提高房颤的检出率。

附：英文原文

Title: Opportunistic screening versus usual care for detection of atrial fibrillation in primary care: cluster randomised controlled trial

Author: Steven B Uittenbogaart, Nicole Verbiest-van Gurp, Wim A M Lucassen, Bjorn Winkens, Mark Nielen, Petra M G Erkens, J André Knottnerus, Henk C P M van Weert, Henri E J H Stoffers

Issue&Volume: 2020/09/16

Abstract:

Objective To investigate whether opportunistic screening in primary care increases the detection of atrial fibrillation compared with usual care.

Design Cluster randomised controlled trial.

Setting 47 intention-to-screen and 49 usual care primary care practices in the Netherlands, not blinded for allocation; the study was carried out from September 2015 to August 2018.

Participants In each practice, a fixed sample of 200 eligible patients, aged 65 or older, with no known history of atrial fibrillation in the electronic medical record system, were randomly selected. In the intention-to-screen group, 9218 patients eligible for screening were included, 55.0% women, mean age 75.2 years. In the usual care group, 9526 patients were eligible for screening, 54.3% women, mean age 75.0 years.

Interventions Opportunistic screening (that is, screening in patients visiting their general practice) consisted of three index tests: pulse palpation, electronic blood pressure measurement with an atrial fibrillation algorithm, and electrocardiography (ECG) with a handheld single lead electrocardiographic device. The reference standard was 12 lead ECG, performed in patients with at least one positive index test and in a sample of patients (10%) with three negative tests. If 12 lead ECG showed no atrial fibrillation, patients were invited for more screening by continuous monitoring with a Holter electrocardiograph for two weeks.

Main outcome measures Difference in the detection rate of newly diagnosed atrial fibrillation over one year in intention-to-screen versus usual care practices.

Results Follow-up was complete for 8874 patients in the intention-to-screen practices and for 9102 patients in the usual care practices. 144 (1.62%) new diagnoses of atrial fibrillation in the intention-to-screen group versus 139 (1.53%) in the usual care group were found (adjusted odds ratio 1.06 (95% confidence interval 0.84 to 1.35)). Of 9218 eligible patients in the intention-to-screen group, 4106 (44.5%) participated in the screening protocol. In these patients, 12 lead ECG detected newly diagnosed atrial fibrillation in 26 patients (0.63%). In the 266 patients who continued with Holter monitoring, four more diagnoses of atrial fibrillation were found.

Conclusions Opportunistic screening for atrial fibrillation in primary care patients, aged 65 and over, did not increase the detection rate of atrial fibrillation, which implies that opportunistic screening for atrial fibrillation is not useful in this setting.

DOI: 10.1136/bmj.m3208

Source: https://www.bmj.com/content/370/bmj.m3208