Stepwise screening of atrial fibrillation in a 75-year-old population: implications for stroke prevention

Atrial fibrillation (AF) is a frequent source of cardiac emboli in patients with ischemic stroke. AF may be asymptomatic and therefore undiagnosed. Screening for silent AF seems suitable in risk populations, however little is known on the yield and cost-effectiveness of such screening.

All inhabitants in the municipality of Halmstad, Sweden aged 75 to 76 years were invited to a stepwise screening program for AF. As a first step, participants recorded a 12-lead ECG and reported their relevant medical history. Those with sinus rhythm on 12-lead ECG, no history of AF, and ≥2 risk factors according to CHADS(2) were invited to a 2-week recording period using a hand-held ECG and asked to record 20 or 30 seconds twice daily and if palpitations occurred. One thousand, three hundred thirty inhabitants were invited, of whom 848 (64%) participated. Previously undiagnosed silent AF was found in 10 (1%) among 848 individuals who recorded 12-lead ECG. Among 81 patients with known AF, 35 (43%) were not on oral anticoagulation treatment. Among 403 persons with ≥2 risk factors for stroke, who completed the hand-held ECG event recording, 30 (7.4%) were diagnosed with paroxysmal AF. Thus 75/848 (9%) of the screened population were candidates for new oral anticoagulation treatment, of those 57 actually started oral anticoagulation treatment.

Stepwise risk factor-stratified AF screening in a 75-year-old population yields a large share of candidates for oral anticoagulation treatment on AF indication.