Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation...

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.