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GPs should routinely take patients’ pulses to detect heart conditions

GPs should be told to routinely take patients’ pulse rates during appointments to prevent strokes, a major study has found.

Researchers looked at a controversial scheme in East London where family doctors were given extra cash to check elderly patients’ pulse.

The study found that the scheme improved the detection rate of a potentially fatal heart condition by 10 per cent.

Known as atrial fibrillation (AF), this is a potentially fatal condition which can lead to strokes and heart failure.

The condition affects at least 800,000 adults in the UK but a further 250,000 are thought to be living with it undiagnosed.

GPs should routinely take patients’ pulses during appointments as it can improve he detection rate of a potentially fatal heart condition by 10 per cent

The financial incentives for pulse checks were introduced in three East London health trusts – City and Hackney, Newham and Tower Hamlets -in 2013 and 2014.

Collectively the health trusts served just over one million patients at 136 GP surgeries.

Doctors’ received extra payments if they checked patients’ pulse ‘opportunistically’, meaning during routine appointments or check-ups.

The money was paid straight to their surgeries for them to spend how they wished.

Researchers from Barts and the London School of Medicine and Dentistry found the detection rates of atrial fibrillation increased by 9.6 per cent after the incentives were introduced.

In 2011, the proportion of over 65s diagnosed with AF was 61 per 1,000 of the population.

By 2017 this had increased to 67.3 per 1,000 and an additional 790 adults had been diagnosed with the condition.

In addition, 93 per cent of the 58,700 patients over 65s had their pulse checked within the past five years.

Before the scheme was introduced, only 7.3 per cent had been checked.

Dr John Robson, the lead author, whose findings are published in the British Journal of General Practice said: ‘This study shows that a programme to increase detection of AF with opportunistic pulse regularity checks…was associated with a rapid adoption of pulse regularity checks.

‘The introduction of pulse regularity checks was associated with a significant increase in the trend of detection of AF.’

Maureen Talbot, senior cardiac nurse at the British Heart Foundation said: ‘Atrial fibrillation affects over one million people in the UK and if someone is living with the condition and doesn’t know it they are far more likely to be at risk of having a potentially deadly stroke.

‘Treatment of people with AF using medication reduces their risk of stroke by two thirds, therefore it is crucial people are diagnosed as early as possible to reduce this risk.

‘This study confirms that regular pulse checks could be the difference between life and death and we fully support the implementation of opportunistic pulse checks.’

But Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said doctors might not always have time to check patients’ pulse during a ten-minute appointment.

‘Taking the pulse is one of the first clinical skills that doctors and nurses learn – and from a GP’s perspective, it is a simple, safe way of finding out quite a lot about a patient’s health, and can be really useful in forming a diagnosis.

‘But this is often not possible given all the other things GPs are expected do during a consultation, and all the questions we need to ask a patient – particularly during the standard ten-minute consultation, that is increasingly unfit for purpose.’

These financial incentive schemes are controversial as GPs are essentially being given extra money to do tasks which are part of their job.

In 2014 the NHS introduced similar financial incentives for dementia whereby doctors were given £55 for every new case diagnosed.

The scheme was scrapped the same year after patient groups branded it unethical.


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