Is screening for AF worthwhile? Stroke risk in a screened population from the SAFE study

Area of Science:

• Cardiology
• Geriatrics
• Public Health

Background:

• Atrial fibrillation (AF) is a major stroke risk factor, with oral anticoagulation therapy being highly effective.
• Active screening strategies improve AF detection compared to routine care.
• The stroke risk profile of screen-detected AF patients requires further investigation.

Purpose of the Study:

• To determine if patients with AF detected via active screening have stroke risk profiles warranting prophylactic anticoagulation.
• To compare stroke risk profiles between opportunistic and systematic AF screening methods.

Main Methods:

• Secondary analysis of data from the Screening for AF in the Elderly (SAFE) study.
• Random allocation of patient cohorts to opportunistic (pulse and ECG) or systematic (postal invitation for ECG) screening.
• Stroke risk assessment using baseline medical data and CHADS2 criteria.

Main Results:

• 149 new AF cases were detected (75 opportunistic, 74 systematic).
• 83% of opportunistically detected AF patients and 78% of systematically detected AF patients had CHADS2 scores ≥1.
• No significant differences in stroke risk profiles were observed between the two screening methods.

Conclusions:

• Opportunistic and systematic screening yield similar stroke risk profiles in newly detected AF patients.
• Active screening for AF in primary care in individuals aged ≥65 is a valuable strategy.
• A high percentage (78-83%) of screen-detected AF patients are eligible for anticoagulation based on CHADS2 criteria.