Systematic and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice .
While both approaches have a comparable effect on the overall AF diagnosis rate , the cost of systematic screening is significantly more than that of opportunistic screening from the perspective of the health service provider .
BACKGROUND Atrial fibrillation ( AF ) is the most common arrhythmia in clinical practice and is a leading cause of morbidity and mortality .
Screening for AF in asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy prior to the onset of symptoms .
However , for screening to be an effective intervention it must improve the detection of AF and provide benefit for those who are detected earlier as a result of screening .
OBJECTIVES The primary objective of this review was to examine whether screening programmes increase the detection of new cases of AF compared to routine practice .
The secondary objectives were to identify which combination of screening strategy and patient population is most effective , as well as assessing any safety issues associated with screening , its acceptability within the target population and the costs involved .
Multifaceted implementation of stroke prevention guidelines in primary care: cluster-randomised evaluation of clinical and cost effectiveness
Objective : To evaluate clinical and cost effectiveness of implementing evidence -based guidelines for the prevention of stroke . Design : Cluster-r and omised trial Setting : Three primary care organisations in the North of Engl and covering a population of 400 000 . Participants : Seventy six primary care teams in four clusters : North , South & West , City I and City II . Intervention : Guidelines for the management of patients with atrial fibrillation and transient ischaemic attack ( TIA )  were developed and implemented using a multifaceted approach including evidence -based recommendations , audit and feedback , interactive educational sessions , patient prompts and outreach visits . Outcomes : Identification and appropriate treatment of patients with atrial fibrillation or TIA , and cost effectiveness . Results : Implementation led to 36 % increase ( 95 % CI 4 % to 78 % ) in diagnosis of atrial fibrillation , and improved treatment of TIA ( odds ratio of complying with guidelines 1.8 ; 95 % CI 1.1 to 2.8 ) . Combined analysis of atrial fibrillation and TIA estimates that compliance was significantly greater ( OR 1.46 95 % CI 1.10 to 1.94 ) in the condition for which practice s had received the implementation programme . The development and implementation of guidelines cost less than £ 1500 per practice . The estimated costs per quality -adjusted life year gained by patients with atrial fibrillation or TIA were both less than £ 2000 , very much less than the usual criterion for cost effectiveness . Conclusions : Implementation of evidence -based guidelines  improved the quality of primary care for atrial fibrillation and TIA . The intervention was feasible and very cost effective . Key components of the model include context ual analysis , strong professional support , clear recommendations based on robust evidence , simplicity of adoption , good communication and use of established networks and opinion leaders
Systematic and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice .
While both approaches have a comparable effect on the overall AF diagnosis rate , the cost of systematic screening is significantly more than that of opportunistic screening from the perspective of the health service provider .
BACKGROUND Atrial fibrillation ( AF ) is the most common arrhythmia in clinical practice and is a leading cause of morbidity and mortality .
Screening for AF in asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy prior to the onset of symptoms .
However , for screening to be an effective intervention it must improve the detection of AF and provide benefit for those who are detected earlier as a result of screening .
OBJECTIVES The primary objective of this review was to examine whether screening programmes increase the detection of new cases of AF compared to routine practice .
The secondary objectives were to identify which combination of screening strategy and patient population is most effective , as well as assessing any safety issues associated with screening , its acceptability within the target population and the costs involved .