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最新証拠報告と体系的なレビュー
Leila C Kahwati1,2, Gary N Asher1,3, Zachary O Kadro1,4
1RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.
JAMA
|January 25, 2022
まとめ
心房細動 (AF) のスクリーニングは,診断されていない症例を多く検出できます. 抗凝固薬は脳卒中と死亡リスクを軽減しますが,全般的な健康上の結果に関する証拠は限られています.
科学分野:
- 心臓病科
- 予防 医学
- 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,脳卒中の重要な危険因子です.
- AFの早期発見と治療は 脳卒中の予防に不可欠です
研究 の 目的:
- 脳卒中歴のない無症状の成人のAFスクリーニングの有効性と有害性に関する証拠をレビューする.
- 予防サービス・タスク・フォースの指針を提示する.
主な方法:
- ランダム化臨床試験 (RCT),試験精度試験,観察試験の体系的なレビューとメタ分析.
- 対象となった研究は,スクリーニング方法,AF患者における抗凝固療法,および報告された有害性に関するものでした.
主要な成果:
- 検診では未診断の AF 症例が増えた. 1つのRCTは,ECGスクリーニングによる複合エンドポイントの潜在的減少を示唆したが,制限があった.
- 抗凝固薬 (ウォルファリン,DOACs) は,AF患者の脳卒中リスクと全因死亡率を大幅に低下させた.
- 抗凝固薬は重度の出血のリスクを増加させたが,推定は不正確であり,一部の分析ではゼロ効果を排除しなかった.
結論:
- AFのスクリーニングは症例の検出を高めることができますが,健康上の結果への影響に関する確固たる証拠は限られています.
- 抗凝固薬は脳卒中とAFでの死亡率の減少に有効ですが,出血のリスクが増加します.
- スクリーンで検出されたAF集団における抗凝固薬の利益と害を評価するために,さらなる研究が必要である.
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