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Mass Screening for Untreated Atrial Fibrillation | Journal Scan
Study Questions:
What is the prevalence of untreated atrial fibrillation (AF) in a systematic screening program using intermittent electrocardiogram (ECG) recordings among 75/76-year-old individuals?
Methods:
One half of the 75/76-year-old population in two Swedish regions was invited to a screening program for AF. Participants without a prior diagnosis of AF underwent intermittent ECG recordings over 2 weeks. If AF was detected, participants were offered oral anticoagulation (OAC).
Results:
A total of 13,331 inhabitants were invited, and 7,173 (53.8%) participated. Among the participants, 218 (3.0%) were found to have a new diagnosis of AF. Of these, 37 (0.5% of the screened population) were found to have AF on their first ECG. A prior diagnosis of AF was known in 666 (9.3%) participants. Total AF prevalence in the screened population was 12.3%. Of participants with known AF, 149 (2.1%) had no OAC treatment. In total, 5.1% of the screened population had untreated AF. Screening resulted in initiation of OAC treatment in 3.7% of the screened population. More than 90% of the participants with previously undiagnosed AF accepted initiation of OAC treatment.
Conclusions:
Mass screening of individuals 75 or 76 years old identified a group of participants who had undiagnosed AF. Initiation of oral anticoagulants among untreated patients was accepted by a large majority of eligible patients.
Perspective:
AF is associated with significant morbidity and mortality. Stroke is the most significant complication of AF, and anticoagulation reduced that risk up to 70%. The present study shows that intermittent ambulatory monitoring is effective at identifying 3% of the general population of 75/76-year-olds. The screening involved a one-lead ECG recorder that sends a 30-second ECG strip; participants placed their thumbs on the device twice daily, and in case of palpitations. The yield of AF screening appears to increase with patients with increasing CHA2DS2-VASc scores, who are also at increased risk of stroke and have the most to benefit from an early diagnosis. While this was a population-based study, insights from this paper may inform screening asymptomatic patients utilizing large databases of electronic medical records. Such a targeted approach would probably be even more cost-effective.
Keywords: Anticoagulants, Atrial Fibrillation, Arrhythmias, Cardiac, Early Diagnosis, Electrocardiography, Ambulatory, Electronic Health Records, Geriatrics, Heart Conduction System, Mass Screening, Monitoring, Ambulatory, Prevalence, Primary Prevention, Risk, Stroke
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