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A prospective 5-year follow-up after population-based systematic screening for atrial fibrillation

Johan Engdahl1, Anders Holmén2, Mårten Rosenqvist1

  • 1Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Mörbygårdsvägen 5, Stockholm, Sweden.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|April 25, 2018
PubMed

Insights

Systematic atrial fibrillation (AF) screening led to high oral anticoagulant (OAC) adherence and a significant reduction in stroke incidence. Silent AF progresses similarly to symptomatic AF, highlighting the population-level benefits of screening.

Area of Science:

  • Cardiology
  • Public Health
  • Geriatrics

Background:

  • Atrial fibrillation (AF) significantly increases thrombo-embolic stroke risk.
  • Oral anticoagulant (OAC) treatment is effective in reducing this risk.
  • Silent (asymptomatic) AF often remains undiagnosed, posing a challenge for stroke prevention.

Purpose of the Study:

  • To investigate long-term OAC treatment adherence after systematic AF screening.
  • To evaluate the natural course of silent AF and its symptoms.
  • To assess the population-level impact of AF screening on stroke incidence.

Main Methods:

  • A population-based AF screening trial was conducted in a Swedish municipality (born 1934-1935).
  • Participants with AF were followed for 5 years regarding OAC adherence and symptoms.
  • Ischaemic stroke incidence was compared between the intervention area and a control area without screening.

Main Results:

  • High adherence to OAC treatment was observed at 5-year follow-up (88%).
  • Silent AF showed a natural course comparable to symptomatic AF.
  • A significant decline in ischaemic stroke incidence was noted in the intervention area post-screening (P=0.003).

Conclusions:

  • Long-term adherence to OAC treatment following AF screening is high.
  • Systematic AF screening demonstrates a beneficial population-level effect on reducing stroke incidence.
  • Early detection and treatment of AF, even silent forms, are crucial for stroke prevention.
Abstract

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