Screening for Atrial Fibrillation

Abstract

ImportanceAtrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence of AF increases with age, from less than 0.2% in adults younger than 55 years to about 10% in those 85 years or older, with a higher prevalence in men than in women. It is uncertain whether the prevalence of AF differs by race and ethnicity. Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter.ObjectiveTo update its 2018 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the benefits and harms of screening for AF in older adults, the accuracy of screening tests, the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care, and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older adults.PopulationAdults 50 years or older without a diagnosis or symptoms of AF and without a history of transient ischemic attack or stroke.Evidence AssessmentThe USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined.RecommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF. (I statement)

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…The US Preventive Services Task Force has concluded that evidence for screening for AF in individuals ≥50 years of age remains lacking. 143…”

“…142 The US Preventive Services Task Force has concluded that evidence for screening for AF in individuals ≥50 years of age remains lacking. 143 A systematic review of 19 studies from 2007 to 2018 identified 24 single-time-point screening studies; 141 220 participants were included, of whom 1539 had newly detected AF. The detection rate adjusted for age and sex was 1.44% (95% CI, 1.13%–1.82%) in those ≥65 years of age and 0.41% in individuals <65 years of age.…”

Screening for atrial fibrillation to prevent stroke in elderly individuals with or without preexisting cardiovascular disease: A post hoc analysis of the randomized LOOP Study

“…Current European guidelines recommend systematic electrocardiogram screening to be considered in individuals aged ≥75 years or at high stroke risk [6], while the most recent US Preventive Services Task Force Recommendation Statement states a lack of sufficient evidence to endorse AF screening [34]. However, this post hoc analysis of the LOOP Study demonstrates that the effects of systematic AF screening on stroke prevention was considerably upheld by high-risk individuals without established CVD.…”

Yield of diagnosis and risk of stroke with screening strategies for atrial fibrillation: a comprehensive review of current evidence

“…Recently, the United States Preventive Services Task Force (USPSTF) 88 published the 2022 updated version of their document dedicated to AF screening, still highlighting their concern about the lack of effectiveness of an AF screening structured pathway as compared to usual care opposed to some risk of adverse events, as anxiety, excessive testing, and overtreatment. Thus, given that current evidence is deemed insufficient to assess the balance of benefits and harms of screening for AF, the agency has expressed against the implementation of screening in asymptomatic adults aged ≥50 years.…”

“…Moreover, performing AF screening do not recognize clear contraindications, while some caution is needed regarding possible adverse effects such stress/anxiety or overdiagnosis/overtreatment. 88 The main point of debate is still related to their effectiveness in reducing risk of stroke and other adverse events. Despite some methodological and contextual limitations of the studies performed so far, the evidence strongly suggests that AF screening strategies are associated with a significant reduction of adverse outcomes.…”