Research Priorities in Atrial Fibrillation Screening

Abstract

Clinically recognized atrial fibrillation (AF) is associated with higher risk of complications, including ischemic stroke, cognitive decline, heart failure, myocardial infarction, and death. It is increasingly recognized that AF frequently is undetected until complications such as stroke or heart failure occur. Hence, the public and clinicians have an intense interest in detecting AF earlier. However, the most appropriate strategies to detect undiagnosed AF (sometimes referred to as subclinical AF) and the prognostic and therapeutic implications of AF detected by screening are uncertain. Our report summarizes the National Heart, Lung, and Blood Institute’s virtual workshop focused on identifying key research priorities related to AF screening. Global experts reviewed major knowledge gaps and identified critical research priorities in the following areas: (1) role of opportunistic screening; (2) AF as a risk factor, risk marker, or both; (3) relationship between AF burden detected with long-term monitoring and outcomes/treatments; (4) designs of potential randomized trials of systematic AF screening with clinically relevant outcomes; and (5) role of AF screening after ischemic stroke. Our report aims to inform and catalyze AF screening research that will advance innovative, resource-efficient, and clinically relevant studies in diverse populations to improve the diagnosis, management, and prognosis of patients with undiagnosed AF.

Feasible approaches and implementation challenges to atrial fibrillation screening: a qualitative study of stakeholder views in 11 European countries

“…Recent studies vindicate the recommendation for opportunistic screening as set out in the ESC guidelines. 51 52 However, the evidence to support more systematic wide-spread screening remains extremely limited and larger randomised trials of the different approaches versus no screening and individual-patient data meta-analysis of these studies 53 to prevent stroke or other adverse outcomes are needed. However, general technical advances such as digital wearables are driving forces for screening and are increasingly applied whether recommended or not.…”

“…It is increasingly recognised that AF frequently is undetected until complications occur, which has given rise to an interest in detecting AF earlier in a preventive healthcare setting. Recent studies vindicate the recommendation for opportunistic screening as set out in the ESC guidelines 51 52. However, the evidence to support more systematic wide-spread screening remains extremely limited and larger randomised trials of the different approaches versus no screening and individual-patient data meta-analysis of these studies53 to prevent stroke or other adverse outcomes are needed.…”

Screening for Atrial Fibrillation

“…Atrial fibrillation burden is often described as low or high, although there is no exact definition or consensus about what constitutes low vs high AF burden. Clinical AF is known to increase stroke risk, but the stroke risk associated with subclinical AF, particularly low-burden or short-duration AF, is less well understood …”

“…Continuous screening strategies yield the longest overall duration of screening. Intermittent or continuous screening may be more likely to detect AF but also may be more likely to detect paroxysmal AF that occurs infrequently or is of short duration …”

“…In general, guidelines recommend anticoagulant therapy for persons at high risk of stroke . It is important to note that stroke risk stratification instruments (eg, CHA 2 DS 2 -VASc [congestive heart failure, hypertension, age ≥75 years {doubled}, diabetes, stroke/transient ischemic attack/thromboembolism {doubled}, vascular disease {prior myocardial infarction, peripheral artery disease, or aortic plaque}, age 65-74 years, sex category {female}]) were developed from populations of patients with clinically diagnosed, not screen-detected, AF …”