Atrial fibrillation screening
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
Early diagnosis of atrial fibrillation and proper prophylactic treatment can prevent numerous related complications, such as stroke and mortality. Since patients older than 65 are more prone to atrial fibrillation and the aforementioned complications, it has been recommended to perform screening at least in this age group. Electrocardiogram (12-lead ECG) has been introduced as the gold standard method for atrial fibrillation screening. Nevertheless atrial fibrillation screening can be done by simply checking pulse. The other reason to support atrial fibrillation screening is the cost effectiveness of it.
Screening
Practice guidelines by the European Society of Cardiology (ESC recommend[1]:
- "Opportunistic screening for AF by pulse taking or ECG rhythm strip is recommended in patients >_65 years of age"
- "It is recommended to interrogate pacemakers and implantable cardioverter defibrillators on a regular basis for AHRE"
- "Systematic ECG screening should be considered to detect AF in individuals aged >_75 years, or those at high risk of stroke.2"
A systematic review of trials through November, 2019 by the Cochrance Collaboration concluded[2]:
- " Evidence suggests that systematic screening and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice"
Randomized controlled trials have looked at various screening methods:
- Implantable loop recorders increased detection, but did not reduce morbidity[3]
- Intermittent electrocardiograms (ECGs) for 14 days reduced a "composite of stroke, systemic embolism, bleeding hospitalization, and death"[4]
- A study of routine pulse check or electrocardiogram during routine office visits found that the annual rate of atrial fibrillation diagnosis in elderly patients improved from 1.04% to 1.63%. Since identification of such patients for prophylactic anticoagulation might in turn reduce the risk of stroke in that age category.[5]
- The estimated sensitivity of the routine primary care visit in the detection of atrial fibrillation is 64%. This low sensitivity probably reflects the fact that the pulse is not being checked routinely or carefully.[5]
Cost effectiveness
- The other reason to support atrial fibrillation screening is the cost effectiveness of it. Based on several studies, since screening prevent numerous atrial fibrillation's complications (such as stroke and mortality). [6][7]
- Other methods such as 7 days Holter monitoring also could be considered for atrial fibrillation screening.[7]
References
- ↑ Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C; et al. (2021). "2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC". Eur Heart J. 42 (5): 373–498. doi:10.1093/eurheartj/ehaa612. PMID 32860505 Check
|pmid=value (help). - ↑ Moran PS, Teljeur C, Ryan M, Smith SM (2016). "Systematic screening for the detection of atrial fibrillation". Cochrane Database Syst Rev (6): CD009586. doi:10.1002/14651858.CD009586.pub3. PMC 7105908 Check
|pmc=value (help). PMID 27258214. - ↑ Svendsen JH, Diederichsen SZ, Højberg S, Krieger DW, Graff C, Kronborg C; et al. (2021). "Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial". Lancet. doi:10.1016/S0140-6736(21)01698-6. PMID 34469766 Check
|pmid=value (help). - ↑ Svennberg E, Friberg L, Frykman V, Al-Khalili F, Engdahl J, Rosenqvist M (2021). "Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial". Lancet. doi:10.1016/S0140-6736(21)01637-8. PMID 34469764 Check
|pmid=value (help). - ↑ 5.0 5.1 Fitzmaurice DA, Hobbs FD, Jowett S, Mant J, Murray ET, Holder R; et al. (2007). "Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial". BMJ. 335 (7616): 383. doi:10.1136/bmj.39280.660567.55. PMC 1952508. PMID 17673732. Review in: Evid Based Med. 2008 Apr;13(2):45
- ↑ Jacobs MS, Kaasenbrood F, Postma MJ, van Hulst M, Tieleman RG (2018). "Cost-effectiveness of screening for atrial fibrillation in primary care with a handheld, single-lead electrocardiogram device in the Netherlands". Europace. 20 (1): 12–18. doi:10.1093/europace/euw285. PMID 27733465.
- ↑ 7.0 7.1 Mayer F, Stahrenberg R, Gröschel K, Mostardt S, Biermann J, Edelmann F; et al. (2013). "Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia". Clin Res Cardiol. 102 (12): 875–84. doi:10.1007/s00392-013-0601-2. PMC 3826055. PMID 23904073.