Development and implementation of a rapid, accurate, and cost-effective protocol for national stroke prevention screening

Lavenson, George S.; Pantera, Richard; Garza, R.; Neff, Tracey; Rothwell, Sue D.; Cisneros, Jane

doi:10.1016/j.amjsurg.2004.08.055

Cited by 24 publications

(23 citation statements)

References 12 publications

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“…This identified 15 references, of which seven studies 19,21,25,[94][95][96][97] were considered relevant after title and abstract screening (reviewed by NJW).…”

Section: Outcomes Of the Economic Evaluationmentioning

confidence: 99%

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

122

116

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BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources.ObjectivesTo conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model.DesignSystematic review, meta-analysis and cost-effectiveness analysis.SettingPrimary care.ParticipantsAdults.InterventionScreening strategies, defined by screening test, age at initial and final screens, screening interval and format of screening {systematic opportunistic screening [individuals offered screening if they consult with their general practitioner (GP)] or systematic population screening (when all eligible individuals are invited to screening)}.Main outcome measuresSensitivity, specificity and diagnostic odds ratios; the odds ratio of detecting new AF cases compared with no screening; and the mean incremental net benefit compared with no screening.Review methodsTwo reviewers screened the search results, extracted data and assessed the risk of bias. A DTA meta-analysis was perfomed, and a decision tree and Markov model was used to evaluate the cost-effectiveness of the screening strategies.ResultsDiagnostic test accuracy depended on the screening test and how it was interpreted. In general, the screening tests identified in our review had high sensitivity (> 0.9). Systematic population and systematic opportunistic screening strategies were found to be similarly effective, with an estimated 170 individuals needed to be screened to detect one additional AF case compared with no screening. Systematic opportunistic screening was more likely to be cost-effective than systematic population screening, as long as the uptake of opportunistic screening observed in randomised controlled trials translates to practice. Modified blood pressure monitors, photoplethysmography or nurse pulse palpation were more likely to be cost-effective than other screening tests. A screening strategy with an initial screening age of 65 years and repeated screens every 5 years until age 80 years was likely to be cost-effective, provided that compliance with treatment does not decline with increasing age.ConclusionsA national screening programme for AF is likely to represent a cost-effective use of resources. Systematic opportunistic screening is more likely to be cost-effective than systematic population screening. Nurse pulse palpation or modified blood pressure monitors would be appropriate screening tests, with confirmation by diagnostic 12-lead electrocardiography interpreted by a trained GP, with referral to a specialist in the case of an unclear diagnosis. Implementation strategies to operationalise uptake of systematic opportunistic screening in primary care should accompany any screening recommendations.LimitationsMany inputs for the economic model relied on a single trial [the Screening for Atrial Fibrillation in the Elderly (SAFE) study] and DTA results were based on a few studies at high risk of bias/of low applicability.Future workComparative studies measuring long-term outcomes of screening strategies and DTA studies for new, emerging technologies and to replicate the results for photoplethysmography and GP interpretation of 12-lead electrocardiography in a screening population.Study registrationThis study is registered as PROSPERO CRD42014013739.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…This identified 15 references, of which seven studies 19,21,25,[94][95][96][97] were considered relevant after title and abstract screening (reviewed by NJW).…”

Section: Outcomes Of the Economic Evaluationmentioning

confidence: 99%

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

122

116

View full text Add to dashboard Cite

show abstract

“…A study of 2559 seniors found that 7.5% had carotid stenoses of Ͼ50%, of which two thirds (5%) were confirmed by further ultrasound study. 15 It is likely that no more than half of these patients had a stenosis Ն80%, a level that many clinicians now use as a criterion for intervention (endarterectomy or stenting) in asymptomatic patients. Of these patients, even if two thirds agreed to surgery, only 1.7% of the total screened cohort would undergo surgery.…”

Section: Ultrasound For Carotid Artery Diseasementioning

confidence: 99%

Atherosclerotic Peripheral Vascular Disease Symposium II

Criqui¹,

Alberts

Fowkes³

et al. 2008

Circulation

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“…This would include the clinical indications for further testing, the methods used for subsequent testing, and their limitations (false positives, false negatives, overall accuracy). 103,108,118 5. How to treat patients with the presence of asymptomatic disease in various vascular beds, the risks and benefits of these various treatments and interventions, and patient education and knowledge of sources for such educational information (i.e., Web sites, nonprofit organizations).…”

Section: Minimal Knowledgementioning

confidence: 99%

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease

Merz

Alberts

Balady³

et al. 2009

Circulation

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Development and implementation of a rapid, accurate, and cost-effective protocol for national stroke prevention screening

Cited by 24 publications

References 12 publications

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Atherosclerotic Peripheral Vascular Disease Symposium II

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease

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