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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Published on: February 28, 2012

Should all patients with atrial fibrillation be screened with echocardiography?

N A Desbiens1

  • 1Department of Medicine, Marshfield Clinic, WI 54449.

Journal of General Internal Medicine
|March 1, 1992
PubMed

Insights

Echocardiography for all atrial fibrillation patients may not be recommended to detect mitral stenosis. The benefits of this strategy are marginal and highly dependent on anticoagulation effectiveness and risks.

Area of Science:

  • Cardiology
  • Medical Decision Making

Background:

  • Atrial fibrillation (AF) increases stroke risk.
  • Undetected mitral stenosis (MS) in AF patients may be a treatable cause of stroke.
  • Quality assurance studies prompt investigation into diagnostic and treatment strategies.

Purpose of the Study:

  • To evaluate the optimal strategy for detecting mitral stenosis in patients with atrial fibrillation.
  • To determine if routine echocardiography is cost-effective for identifying mitral stenosis to guide anticoagulation and prevent strokes.

Main Methods:

  • Decision analysis using a Markov-chain model.
  • Quality-adjusted life expectancy was used as the outcome measure.
  • Five strategies were compared, including routine echocardiography, targeted echocardiography, and various anticoagulation protocols.

Main Results:

  • Performing echocardiography on all AF patients yielded the highest quality-adjusted life expectancy.
  • However, the differences in life expectancy among the five strategies were minimal.
  • Sensitivity analyses indicated that the decision is sensitive to anticoagulation efficacy and risks.

Conclusions:

  • A definitive recommendation for routine cardiac ultrasonography in all AF patients to detect unrecognized mitral stenosis cannot be made.
  • The decision-making process is complex and influenced by individual patient factors and treatment uncertainties.
Abstract

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