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Should This Patient Be Screened for Atrial Fibrillation?: Grand Rounds Discussion From Beth Israel Deaconess Medical
Risa B Burns1, Peter Zimetbaum1, Steven A Lubitz2
1Beth Israel Deaconess Medical Center, Boston, Massachusetts (R.B.B., P.Z., G.W.S.).
Annals of Internal Medicine
|December 3, 2019
Summary
Atrial fibrillation (AFib) screening using ECG may detect more cases than usual care, but evidence for its effectiveness in older adults is debated. Cardiologists discuss the benefits and risks of AFib screening and anticoagulation.
Area of Science:
- Cardiology
- Public Health
- Medical Diagnostics
Background:
- Atrial fibrillation (AFib) is a prevalent cardiac arrhythmia impacting millions in the U.S.
- AFib detection can occur through various methods, including electrocardiograms (ECG), monitors, consumer devices, pulse palpation, and auscultation.
- Early detection of AFib is crucial due to its significant association with stroke risk.
Observation:
- Systematic reviews indicate ECG screening identifies more new AFib cases compared to no screening.
- The U.S. Preventive Services Task Force found insufficient evidence for ECG screening's superiority over usual care in adults aged 65+.
- International guidelines suggest active AFib screening may benefit older populations.
Findings:
- The effectiveness of ECG screening for AFib in older adults remains a subject of differing expert opinions.
- There is ongoing discussion regarding the optimal approach to AFib screening and subsequent anticoagulation therapy.
- Cardiologists weigh the risks and benefits of screening and anticoagulation for screen-detected AFib.
Implications:
- Clarifying the role of AFib screening can improve stroke prevention strategies.
- Further research may resolve discrepancies in screening recommendations for older adults.
- Optimizing anticoagulation protocols for screen-detected AFib is essential for patient outcomes.
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