Large‐scale screening studies for atrial fibrillation – is it worth the effort?

Engdahl, Johan; Rosenqvist, Mårten

doi:10.1111/joim.13217

Cited by 14 publications

(15 citation statements)

References 83 publications

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“…As predicted, AF epidemic approached the physician 'door [42]. Several large-scale AF screening studies are ongoing [43]. They will shed further light on lifetime risk in general population and risk factors related to AF development and they will point out strategies for primordial prevention.…”

Section: Discussionmentioning

confidence: 98%

Atrial Fibrillation is Not A Dead Horse

Fiori¹,

Lia²,

Guglielmo³

et al. 2022

J Med - Clin Res & Rev

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Prevalence and incidence of Atrial Fibrillation (AF) is high in western countries. It is apparently lower in developing countries, because of unrecognition, undertreatment and related complications and mortality. Studies in subjects wearing cardiac implantable electronic devices showed a wide burden of AF, ranging from subclinical episodes to permanent AF. The aim of our study was to identify haematological and haemodynamic differences between Paroxysmal Atrial Tachyarrhythmias (PAT) compared to Non-Paroxysmal AF (NPAF), detected by 24 hours Holter ECG, and predictive negative factors associated with increased risk of evolution from paroxysmal to persistent or permanent AF. Our data highlight the dynamic nature of PAT and NPAF. PAT in young subjects is a red flag, requiring at least changes in lifestyle and further diagnostic examinations to avoid progression to irreversible pathological myocardial electrical and structural remodeling. Comorbidities, scarce compliance, or inappropriate treatments account for high incidence of acute cerebrovascular events with disabling outcomes in elderly patients. Further studies are needed on genetic susceptibility and vulnerability. Educational campaign is the most effective, long- term strategy. Personalized approach and therapeutical scheme are recommended based on patient compliance and actual risk. A holistic approach to patient is the pillar for any clinical decision and practice.

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Section: Discussionmentioning

confidence: 98%

Atrial Fibrillation is Not A Dead Horse

Fiori¹,

Lia²,

Guglielmo³

et al. 2022

J Med - Clin Res & Rev

View full text Add to dashboard Cite

show abstract

“… 23 With the expected surge in AF prevalence, 3 24 25 this underlines that a suited screening strategy is needed to identify and treat AF to mitigate mortality, morbidity, and health care expenses. 26 27 But before this, evidence is needed with regard to OAC treatment in subclinical AF. 15 Indeed, screening AF is gaining momentum but remains unknown territory with respect to side effects—that is, early detection and treatment may come with a different risk-benefit trade-off compared with what is known from conventionally diagnosed AF.…”

Section: Discussionmentioning

confidence: 99%

“…The percentage of AF-patients treated with OAC in the American cohort was low (41 %) compared to the current study (87.1%), and yet the registry reported a significantly lower all-cause and inpatient medical cost for OAC-treated AF patients compared to their non-treated cohort 23 . With the expected surge in AF prevalence 3,24,25 this underlines that a suited screening strategy is needed to identify and treat AF to mitigate mortality, morbidity and health care expenses 26,27 . But before this, evidence is needed with regards to OACtreatment in subclinical AF 15 .…”

Section: Bleeding Ratesmentioning

confidence: 99%

Anticoagulation-Associated Bleeding in Patients Screened for Atrial Fibrillation versus Usual Care—A Post Hoc Analysis from the LOOP Study

Kongebro,

Diederichsen,

Xing

et al. 2023

TH Open

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Background Atrial fibrillation (AF) prevalence is rising, however data on the bleeding risks associated with detection of subclinical AF are needed. Objective To determine the bleeding increment associated with implantable loop recorder (ILR) screening for subclinical AF and subsequent anticoagulation initiation compared to usual care. Methods This post-hoc study utilized LOOP trial data from 6004 elderly patients with stroke risks randomised to either ILR (n=1503) or usual care (n=4503). The mean follow-up time was 64.5 months, and none were lost to follow-up. The primary exposure was the initiation of oral anticoagulation, and the main outcome was the risk of major bleeding events following initiation of oral anticoagulants (OAC), determined by time-dependent cox regression. Secondly, we investigated antithrombotic prescription patterns and major bleeding events after antiplatelets treatment and in subgroups. Results OAC was initiated in 1019 participants with a mean age (yrs) at 78.8 (±4.67) in Control vs. 77.0 (±4.84) in ILR, p<0.0001. All cases of OAC discontinuation reached 202, and in AF-patients (n=910) alone paused 105 (72%) paticipants temporarily OAC and 40 (28%) ended OAC treatment completelety during follow-up. Major bleeding events totalled 221 (3.7%). Forty-seven major bleeding events followed an OAC initiation in 1019 participants (4.6%); 26 vs. 21 events in the control and ILR group respectively. The hazard ratio (HR) for major bleeding after OAC initiation compared to before was 2.08 (1.50-2.90) p<0.0001 overall; 2.81 (1.82-4.34) p<0.0001 for Control and 1.32 (0.78-2.23) p=0.31 for the ILR group (p=0.07 for interaction). Antiplatelet treatment resulted in an overall adjusted HR of 1.3 (0.96-1.75) p=0.09. For OAC-users aged ≥75 years in the ILR group, the rate of major bleeding was 1.73 (0.92-2.96) compared to 0.84 (0.36-1.66) for an age <75 years, and the rate of the corresponding Control subgroup aged ≥75 years was 2.20 (1.23-3.63) compared to 1.64 (0.82-2.93) for an age <75 years. Conclusion The individual risk of major bleeding increased two-fold after initiation of oral anticoagulation for all patients in this study. However, the patients screened for subclinical AF did not have a higher bleeding risk after initiation of anticoagulation compared to those in usual care.

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“…The WHO defines screening as the presumptive identification of unrecognized disease in an apparently healthy, asymptomatic population by means of tests, examinations or other procedures that can be applied rapidly and easily to the target population [1]. This definition excludes surveillance and/ or opportunistic screening, as those strategies do not adhere to the criteria of 'an apparently healthy and asymptomatic population'.…”

Section: Definitionmentioning

confidence: 99%

“…In the current issue, the challenges with large‐scale screenings are discussed in two reviews dealing with early detection of atrial fibrillation [1] and colorectal cancer [2].…”

mentioning

confidence: 99%