Screening for Atrial Fibrillation: A Perspective From Critical Appraisal of the Guidelines

Current guidelines involving screening for atrial fibrillation (AF) have some discrepancies in the recommendations for AF screening, which might confuse clinicians. Therefore, it is necessary to appraise the quality of the guidelines and summarize the consensus and discrepancies regarding AF screening.

A systematic search was conducted for guidelines containing recommendations for AF screening between 2012 and 2024. Two reviewers appraised the quality of the included guidelines with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.

Seven guidelines met the inclusion criteria, with AGREE II scores ranging from 42% to 80%, of which 4 guidelines were defined as 'strongly recommended' guidelines. Most current guidelines reach consensus that AF screening should be performed in individuals aged ≥ 65 years and patients with stroke or cardiac implantable electronic devices (CIED). However, there was no consensus on whether to perform systematic ECG screening in patients ≥ 75 years of age and the optimal method of prolonged ECG monitoring in patients with stroke. Moreover, the recommendation regarding AF screening in other subgroups was limited.

The guidelines from European and American regions had higher AGREE II scores. Most of the current guidelines reached consensus that the elderly population (≥ 65 years) and patients with stroke or CIED need AF screening, but there was no consensus on the methods or intensity of screening for specific subgroups.