Tests for AF in GP practices.

[TonyRands]

Our GP practice in Chipping Norton has begun a regular walk-in/no booking service. When I used it a few weeks ago, the triage nurse gave me a form to fill in before she examined me before seeking the GP. Part of the examination was a pulse reading, and the form which went to the GP asked her specifically to note whether the pulse was regular or irregular. I don't know if this is confined to our health centre, or whether it is more widespread across GP practices. Does anyone have any information about this? If it were widespread it could be one way of finding some of the thousands with af who are unaware of it.

[BobD Volunteer]

This is something which AF Association have been campaigning for for years but I do not think it is a government initiative. We do know that some 8000 odd strokes a year could be prevented if more people were identified and anticoagulated if at risk so any such scheme is welcome.

[Rellim296]

I had my pulse taken when I went for a blood test, and reminded the nurse that she already knew I had AF and was she checking that I was still alive.

Given that I have had a 7 day monitor that showed up nothing but sinus rhythm, surely asking patients if their hearts misbehave sometimes might catch in the net those like me who have paroxsmal AF as well as taking patients' pulses to find asymptomatic permanent AFers.

[10gingercats]

My GP often takes my wrist casually(no, he is not be overfriendly!) while I am in the surgery.He is very aware and sometimes remarks on my composure or complexion.....not always favourably!

[BobD Volunteer]

No good doing my right wrist as it doesn't have a pulse since my angiogram . I have endless fun with that telling people I am actually dead. lol

[SRMGrandma Volunteer]

I have never known of any medical facility that does not do basic vital signs including both radial and apical pulse (listening with stethoscope) on every single patient, no matter what the complaint. Insurance requires it. Noting vital signs including the rate and characteristics of pulse is standard medical care. That said, it won't pick up paroxysmal A.F. Picking up AF in persons who avoid routine medical care is another matter. Thats where the awareness comes in, but of course people who are not fans of preventative care may not be receptive to pleas to have their pulse checked!

[Beancounter Volunteer in reply to SRMGrandma]

Hi SRMGrandma

I only wish that were true in the UK, "basic vital signs" usually means sticking your arm into a machine often with a chair in front of it, and as you know well, if you are in AF not only do they get your pulse wrong they get your BP wrong as well.

At a recent Pre-Op assessment when the "nurse" (she hardly deserves the name, she was so poor) thought my BP was ridiculously high and eventually listened to me being in AF and the machine not working, she said OK you need a manual BP then, "yes" I said, and I quote. "Then I shall have to go and get someone who knows how to do one"

GPs are trying to save time, and I get that, and I get that nurses should be able to take vital signs and assist doctors in that way, but PLEASE train them that machines do not work for 100% of the population. My GP still doesn't listen I have given up on ever getting a manual BP reading from them, I check it myself.

Rant over

Be well

Ian

[SRMGrandma Volunteer in reply to Beancounter]

Yikes, Ian, that is frustrating for sure! Around here the medical assistant may use a machine for BP during initial check in, but I have never ever not had a doc use his/her stethoscope and do a good long listen to my heart as well as a manual pulse check. I'd be ranting too!!

[Jamila123]

Or educate people in taking their own pulse which is extremely easy skill to learn 🌺

[WendyWu20]

Peripheral pulses, such as the radial, often do not reflect the actual beats of the heart in AF, as the ventricular contractions aren't strong enough to reach that far. When I'm in AF (like right now!) I often can't feel my radial pulse at all although my heart sensations are more than obvious :o)

[ILowe]

There is a case for some of the sturdy portable ECG monitors being made available for loan or rent. I have one for myself. I use it to take records when I feel something is odd, just in case my PIP fails. I have used it to distinguish between AF and tachycardia. It also does a good job of counting the true heart rate. A few weeks ago, a friend felt something, so he used my machine, then showed the result to a doctor. They were promptly put on anticoagulation and checks of the heart, lung function etc.

My portable ECG has really helped someone who only has AF occasionally. it has also triggered some needed checks.

[Beancounter Volunteer]

This is excellent Tony, and certainly best practice, you have got a good one there stick with that GP.

I would guesss that maybe 5% to 10% of GPs do that I regret to say

Be well

Ian

[TonyRands in reply to Beancounter]

Hi Ian, the thing I think is good about our practice is the quick test is done on everyone who comes to the walk in surgery, even for something simple where the GP might not immediately think of using the stethoscope. That could possibly catch those who would normally not visit a GP.

[Bagrat]

Some people hear/feel what they expect to feel. GP reg. took my pulse and said " oh yes I'd expect it to be like that with AF" I pointed out having taken my pulse that I was not in AF and can only think he caught a couple of ectopics. When I trained in the 60s many patients had to have "apex and radials" which involved 2 nurses one taking pulse at wrist and one listening to heart simultaneously. I would be interested to know if it happens now as have not come across it for many years