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Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation
, Susan J Curry1, Alex H Krist2,3
1University of Iowa, Iowa City.
Insights
Screening older adults for atrial fibrillation (AF) using electrocardiography (ECG) has insufficient evidence to determine its net benefit. The US Preventive Services Task Force found that while AF increases stroke risk, the harms of screening and treatment outweigh proven benefits.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Atrial fibrillation (AF) is the most common cardiac arrhythmia, with prevalence increasing significantly with age.
- AF is a major risk factor for ischemic stroke, increasing stroke risk up to fivefold.
- About 20% of stroke patients with AF are diagnosed with the condition at the time of stroke.
Purpose of the Study:
- To inform a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation (AF) using electrocardiography (ECG).
Main Methods:
- USPSTF systematically reviewed evidence on the benefits and harms of ECG screening for AF in adults aged 65 and older.
- Evaluated the effectiveness of ECG screening versus usual care for detecting undiagnosed AF.
- Assessed the benefits and harms of anticoagulant or antiplatelet therapy for screen-detected AF.
Main Results:
- Most older adults with undiagnosed AF have a stroke risk warranting anticoagulant therapy.
- Anticoagulant therapy effectively prevents strokes in symptomatic AF patients with high stroke risk.
- Inadequate evidence exists to confirm if ECG screening and subsequent treatment improve outcomes in asymptomatic adults compared to usual care.
Conclusions:
- The USPSTF found insufficient evidence to assess the balance of benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older.
- Potential harms include misdiagnosis and invasive follow-up testing.
- The net benefit of ECG screening for AF remains uncertain.
Importance:
Atrial fibrillation is the most common type of cardiac arrhythmia (irregular heartbeat), and its prevalence increases with age, affecting about 3% of men and 2% of women aged 65 to 69 years and about 10% of adults 85 years and older. Atrial fibrillation is a major risk factor for ischemic stroke, increasing risk of stroke by as much as 5-fold. Approximately 20% of patients who have a stroke associated with atrial fibrillation are first diagnosed with atrial fibrillation at the time of stroke or shortly thereafter.
Objective:
To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation with electrocardiography (ECG).
Evidence Review:
The USPSTF reviewed the evidence on the benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older, the effectiveness of screening with ECG for detecting previously undiagnosed atrial fibrillation compared with usual care, and the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected atrial fibrillation in older adults.
Findings:
Most older adults with previously undiagnosed atrial fibrillation have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment. Anticoagulant therapy is effective for stroke prevention in symptomatic persons with atrial fibrillation and high stroke risk. However, the USPSTF found inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established and include misdiagnosis and invasive testing. Given these uncertainties, it is not possible to determine the net benefit of screening with ECG.
Conclusions And Recommendation:
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement).
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