Study Suggests Stepwise Screening of AFib Provides Better Stroke Prevention

A study published on Jan. 23 in Circulation, found that stepwise risk factor-stratified atrial fibrillation (AFib) screening in a 75-year old population yields a large share of candidates for oral anticoagulation treatment (OAC) on AFib indication, and can provide better stroke prevention.

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As little is known on the yield and cost-effectiveness of screening for silent AFib, the study looked at 848 participants ages 75-76 in Halmstad, Sweden. Participants recorded a 12-lead electrocardiogram (ECG) and reported their relevant medical history, and those with sinus rhythm on 12-lead ECG, no history of AFib, and at least two risk factors according to the CHADS2 risk classification were invited to participate in a two-week recording period using a hand-held ECG, and were asked to record 20 or 30 seconds twice daily and if palpitations occurred.

Results showed previously undiagnosed silent AFib were found in ten participants (1 percent) who recorded 12-lead ECG. Among 81 patients with known AFib, 35 participants (43 percent) were not on OAC treatment. In 403 participants with at least two risk factors for stroke, who completed the hand-held ECG event recording, 30 participants (7.4 percent) were diagnosed with paroxysmal AFib. Therefore, 75 participants (9 percent) were candidates for new OAC treatment, and of those 57 actually started OAC treatment. Further, the authors note that stepwise risk factor-stratified AFib screening identified a total prevalence of 14 percent, of which 62 percent had no OAC treatment, and the amount of OAC treatment on AFib indication more than doubled among the screened participants.

"Unfortunately, OAC is withheld among half of patients with already know AFib and risk factors," note the authors. "This study implies that patients with previously diagnosed and not yet diagnosed AFib can get better stroke prevention within a screening program," they add.

Keywords: Prevalence, Stroke, Sweden, Heart Conduction System, Atrial Fibrillation, Risk Factors, Electrocardiography

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