Screening to identify unknown atrial fibrillation. A systematic review

Area of Science:

• Cardiology
• Public Health
• Preventive Medicine

Background:

• Atrial fibrillation (AF) significantly elevates stroke risk.
• Stroke risk in AF is preventable with oral anticoagulant therapy (OAC).
• Undiagnosed AF poses a silent threat, often preceding stroke detection.

Purpose of the Study:

• To evaluate the effectiveness of single time-point AF screening for identifying undiagnosed cases.
• To determine if screening yields sufficient numbers for effective stroke prevention.
• To assess the yield of AF screening in a general adult population.

Main Methods:

• Systematic review of clinical trials.
• Searched electronic medical databases, reference lists, and grey literature.
• Included studies using electrocardiography or pulse palpation in general ambulant adults.

Main Results:

• 30 studies (n=122,571) identified; overall AF prevalence was 2.3%.
• AF prevalence increased to 4.4% in individuals aged ≥65 years.
• Previously unknown AF incidence was 1.0% overall, rising to 1.4% in those ≥65 years; 67% of these were high stroke risk.

Conclusions:

• Single time-point screening identifies a notable percentage of previously undiagnosed AF, especially in older adults.
• Screening facilitates OAC eligibility, crucial for stroke prevention in identified individuals.
• Community-based AF screening in at-risk older populations can potentially decrease the burden of AF-related health issues.