Validity of daily self-pulse palpation for atrial fibrillation screening in patients 65 years and older: A cross-sectional study

Autoři: Faris Ghazal aff001;  Holger Theobald aff002;  Mårten Rosenqvist aff001;  Faris Al-Khalili aff001
Působiště autorů: Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden aff001;  Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden aff002
Vyšlo v časopise: Validity of daily self-pulse palpation for atrial fibrillation screening in patients 65 years and older: A cross-sectional study. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003063
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003063



The European Society of Cardiology guidelines recommend (Class IA) single-time–point screening for atrial fibrillation (AF) using pulse palpation. The role of pulse palpation for AF detection has not been validated against electrocardiogram (ECG) recordings. We aimed to study the validity of AF screening using self-pulse palpation compared with an ECG recording conducted at the same time using a handheld ECG 3 times a day for 2 weeks.

Methods and findings

In this cross-sectional screening study, patients 65 years of age and older attending 4 primary care centers (PCCs) outside Stockholm County were invited to take part in AF screening from July 2017 to December 2018. Patients were included irrespective of their reason for visiting the PCC. Handheld intermittent ECGs 3 times per day were offered to patients without AF for a period of 2 weeks, and patients were instructed in how to take their own pulse at the same time. A total of 1,010 patients (mean age 73 years, 61% female, with an average CHA2DS2-VASc score 2.9) participated in the study, and 27 (2.7%, 95% CI 1.8%–3.9%) new cases of AF were detected. Anticoagulants (ACs) could be initiated in 26 (96%, 95% CI 81%–100%) of these cases. A total of 53,782 simultaneous ECG recordings and pulse measurements were registered. AF was verified in 311 ECG recordings, of which the pulse was palpated as irregular in 77 recordings (25%, 95% CI 20%–30% sensitivity per measurement occasion). Of the 27 AF cases, 15 cases felt an irregular pulse on at least one occasion (56%, 95% CI 35%–75% sensitivity per individual). 187 individuals without AF felt an irregular pulse on at least one occasion. The specificity per measurement occasion and per individual was (98%, 95% CI 98%–98%) and (81%, 95% CI 78%–83%), respectively.


AF screening using self-pulse palpation 3 times daily for 2 weeks has lower sensitivity compared with simultaneous intermittent ECG. Thus, it may be better to screen for AF using intermittent ECG without stepwise screening using pulse palpation. A limitation of this model could be the reduced availability of handheld ECG recorders in primary care centers.

Klíčová slova:

Atrial fibrillation – Cell phones – Electrocardiography – Ischemic stroke – Nurses – Primary care – Screening guidelines – Sweden


1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;38: 2893–2962.

2. Jaakkola J, Mustonen P, Kiviniemi T, Hartikainen JE, Palomaki A, Hartikainen P, et al. Stroke as the First Manifestation of Atrial Fibrillation. PLoS ONE. 2016;11(12):e0168010. doi: 10.1371/journal.pone.0168010 27936187

3. Mahajan R, Perera T, Elliott AD, Twomey DJ, Kumar S, Munwar DA, et al. Subclinical device-detected atrial fibrillation and stroke risk: a systematic review and meta-analysis. Eur Heart J. 2018;39(16):1407–15. doi: 10.1093/eurheartj/ehx731 29340587

4. Engdahl J, Holmen A, Rosenqvist M, Stromberg U. A prospective 5-year follow-up after population-based systematic screening for atrial fibrillation. Europace. 2018;20(FI_3):f306–f11. doi: 10.1093/europace/euy045 29688312

5. Potpara TS, Lip GY. A brief history of ‘lone’ atrial fibrillation: from ‘a peculiar pulse irregularity’ to a modern public health concern. Curr Pharm Des. [Review]. 2015;21(5):679–96. doi: 10.2174/1381612820666140929100209 25269559

6. Svennberg E, Engdahl J, Al-Khalili F, Friberg L, Frykman V, Rosenqvist M. Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study. Circulation. 2015;131(25):2176–84. doi: 10.1161/CIRCULATIONAHA.114.014343 25910800

7. Lowres N, Neubeck L, Redfern J, Freedman SB. Screening to identify unknown atrial fibrillation. A systematic review. Thromb Haemost. 2013;110(2):213–22. doi: 10.1160/TH13-02-0165 23595785

8. Mairesse GH, Moran P, Van Gelder IC, Elsner C, Rosenqvist M, Mant J, et al. Screening for atrial fibrillation: a European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE). Europace. 2017;19(10):1589–623. doi: 10.1093/europace/eux177 29048522

9. Jaakkola J, Vasankari T, Virtanen R, Juhani Airaksinen KE. Reliability of pulse palpation in the detection of atrial fibrillation in an elderly population. Scandinavian journal of primary health care. 2017;35(3):293–8. doi: 10.1080/02813432.2017.1358858 28784027

10. Jaakkola J, Virtanen R, Vasankari T, Salminen M, Airaksinen KEJ. Self-detection of atrial fibrillation in an aged population: three-year follow-up of the LietoAF intervention study. BMC Geriatr. 2017;17(1):218. doi: 10.1186/s12877-017-0607-0 28915862

11. Ghazal F, Theobald H, Rosenqvist M, Al-Khalili F. Feasibility and outcomes of atrial fibrillation screening using intermittent electrocardiography in a primary healthcare setting: A cross-sectional study. PLoS ONE. 2018;13(5):e0198069. doi: 10.1371/journal.pone.0198069 29795689

12. Engdahl J, Andersson L, Mirskaya M, Rosenqvist M. Stepwise screening of atrial fibrillation in a 75-year-old population: implications for stroke prevention. Circulation. 2013 Feb 26;127(8):930–7. doi: 10.1161/CIRCULATIONAHA.112.126656 23343564

13. Taggar JS, Coleman T, Lewis S, Heneghan C, Jones M. Accuracy of methods for detecting an irregular pulse and suspected atrial fibrillation: A systematic review and meta-analysis. Eur J Prev Cardiol. 2016 Aug;23(12):1330–8. doi: 10.1177/2047487315611347 26464292

14. Chan PH, Wong CK, Poh YC, Pun L, Leung WW, Wong YF, et al. Diagnostic Performance of a Smartphone-Based Photoplethysmographic Application for Atrial Fibrillation Screening in a Primary Care Setting. J Am Heart Assoc. 2016 Jul 21;5(7).

15. Sandhu RK, Healey JS. Screening for undiagnosed atrial fibrillation. Expert Rev Cardiovasc Ther. 2018 Aug;16(8):591–8. doi: 10.1080/14779072.2018.1496018 29963930

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