エレクトロカーディオグラフィによる心房細動のスクリーニング:米国予防サービスタスクフォースの勧告声明
, Susan J Curry1, Alex H Krist2,3
1University of Iowa, Iowa City.
JAMA
|August 9, 2018
まとめ
高齢者の心房細動 (AF) のスクリーニングは,心電図 (ECG) を用いてその純利益を決定するのに十分な証拠がありません. 米国予防サービスタスクフォースは AFは脳卒中のリスクを高めますが 検診と治療の害は 証明された利点よりも大きいことを発見しました
科学分野:
- 心臓病科
- 予防 医療
- 公衆衛生
背景:
- 心房細動 (AF) は最も一般的な心律動乱であり,その罹患率は年齢とともに著しく増加する.
- AFは脳卒中の主な危険因子であり,脳卒中のリスクは5倍まで増加します.
- 脳卒中患者の約20%は 脳卒中時に診断される.
研究 の 目的:
- 心電図 (ECG) を用いた心房細動 (AF) のスクリーニングに関する新しいUSPSTFの勧告を参考にすること.
主な方法:
- USPSTFは,65歳以上の成人のAFに対するECGスクリーニングの利益と害に関する証拠を体系的に検討した.
- 診断されていないAFを検出するための通常のケアと比較して,ECGスクリーニングの有効性を評価した.
- スクリーンで検出されたAFに対する抗凝固剤または抗血小板治療の利益と害を評価した.
主要な成果:
- 診断されていないAFの高齢者のほとんどは,抗凝固剤の治療を必要とする脳卒中のリスクがあります.
- 抗凝固剤治療は,脳卒中のリスクが高い症状のあるAF患者の脳卒中を効果的に予防します.
- 症状のない成人の場合,EKGスクリーニングとその後の治療が通常の治療と比較して結果を改善するかどうかを確認するための十分な証拠は存在しません.
結論:
- USPSTFは,65歳以上の成人の心房細動のスクリーニングの利益と害のバランスを評価するのに十分な証拠が見つかりませんでした.
- 潜在的な害には誤診と侵襲的な追跡検査が含まれます.
- AFのEKGスクリーニングの純利益は不明である.
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