Stepwise Screening of Atrial Fibrillation in a 75-Year Old Population: Implications for Stroke Prevention
How cost-effective is screening for atrial fibrillation (AF) in an at-risk population?
The subjects of this study were 848 individuals, 75-76 years of age, who lived in Halmstad, Sweden. These subjects underwent a baseline medical evaluation including a 12-lead electrocardiogram. Transtelephonic electrocardiographic monitoring with a handheld device for 20-30 seconds twice daily for 2 weeks was performed in a subset of 403 patients with a CHADS2 score ≥2 and no history of AF. Anticoagulation was recommended for patients found to have AF.
A previous diagnosis of AF was confirmed in 81/848 individuals (9.6%). Thirty-five of the 81 patients (43%) were not taking an anticoagulant, of whom 17 (52%) started anticoagulation therapy upon recommendation. The screening 12-lead electrocardiogram identified 10 patients (1.2%, mean CHADS2 score 1.8) with previously undiagnosed AF. Extended monitoring in 403 individuals identified previously undiagnosed AF in 7.4% (mean CHADS2 score 2.5). The overall prevalence of AF in the 848 subjects was 14.3%. The prevalence was 5.2% in the subjects with no history of AF.
The authors concluded that screening for AF can identify a large number of suitable candidates for anticoagulation in an at-risk population.
Current American and European guidelines recommend screening for AF in the primary care setting in patients 65 years or older with an electrocardiogram if an irregular pulse is found by palpation. The present study demonstrates that a much larger number of patients with asymptomatic AF who are at risk of stroke can be identified by transtelephonic monitoring for 2 weeks. Initiation of anticoagulation in these patients potentially could prevent strokes. The cost-effectiveness of this approach remains to be determined.
Keywords: Prevalence, Blood Coagulation, Stroke, Sweden, Cardiology, Electrocardiography, Palpation, United States
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