Screening for Atrial Fibrillation

Kahwati, Leila C.; Asher, Gary; Kadro, Zachary O.; Keen, Susan; Ali, Rania; Coker-Schwimmer, Emmanuel; Jonas, Daniel E

doi:10.1001/jama.2021.21811

Cited by 30 publications

(35 citation statements)

References 54 publications

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“…These 2 trials reported statistically significant absolute risk increases of 3% and 4.8% in detection of AF for screening vs no screening or delayed screening. The USPSTF found no trials that compared screening for AF with consumer-oriented devices vs no screening …”

Section: Update Of Previous Uspstf Recommendationmentioning

confidence: 99%

“…The Detecting and Diagnosing Atrial Fibrillation trial did not report sensitivity or specificity . However, in that trial, if the screening test result is considered positive if any of its components (pulse palpation, oscillometric blood pressure measurement with automated AF detection, and single-lead ECG with automated AF detection) were positive, the positive predictive value was 6% and the negative predictive value was 100% …”

Section: Update Of Previous Uspstf Recommendationmentioning

confidence: 99%

“…The USPSTF reviewed several trials, systematic reviews, and an observational study that reported on harms associated with anticoagulant therapy. Anticoagulant therapy was associated with an increased risk of bleeding, including major bleeding, extracranial bleeding, intracranial bleeding, and minor bleeding events, although the increased risk was not statistically significant for all outcomes . Similar to the body of evidence on the benefits of anticoagulant treatment, the studies reporting on harms were focused on persons with clinical, usually long-standing, persistent AF; none focused on screen-detected populations .…”

Section: Update Of Previous Uspstf Recommendationmentioning

confidence: 99%

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Screening for Atrial Fibrillation

Davidson

Barry

Mangione

et al. 2022

JAMA

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ImportanceAtrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence of AF increases with age, from less than 0.2% in adults younger than 55 years to about 10% in those 85 years or older, with a higher prevalence in men than in women. It is uncertain whether the prevalence of AF differs by race and ethnicity. Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter.ObjectiveTo update its 2018 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the benefits and harms of screening for AF in older adults, the accuracy of screening tests, the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care, and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older adults.PopulationAdults 50 years or older without a diagnosis or symptoms of AF and without a history of transient ischemic attack or stroke.Evidence AssessmentThe USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined.RecommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF. (I statement)

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Section: Update Of Previous Uspstf Recommendationmentioning

confidence: 99%

Section: Update Of Previous Uspstf Recommendationmentioning

confidence: 99%

Section: Update Of Previous Uspstf Recommendationmentioning

confidence: 99%

See 1 more Smart Citation

Screening for Atrial Fibrillation

Davidson

Barry

Mangione

et al. 2022

JAMA

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“…The authors concluded that they had demonstrated a small benefit of the screening. As described in the USPSTF Evidence Review, 6 the study was judged to be only fair quality because of lack of masking of the intervention and lack of central outcomes determination.…”

mentioning

confidence: 99%

“…The other new evidence since the 2018 USPSTF report addressed other questions besides key question 1 of the Evidence Review commissioned by the task force ("Does screening for AF with selected tests improve health outcomes [ie, reduce all-cause mortality, reduce morbidity or mortality from stroke, or improve quality of life] in asymptomatic older adults?"). 6 As such, based on this additional evidence, the USPSTF did not change its I statement.…”

mentioning

confidence: 99%

Screening for Atrial Fibrillation—More Data Still Needed

Greenland

2022

JAMA

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Updated USPSTF Guidelines for Screening for Atrial Fibrillation

Passman

Freedman

2022

JAMA Cardiol

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Five decades of research have illuminated the role of nonvalvular atrial fibrillation (AF) in the pathogenesis of stroke, heart failure, dementia, and premature death. Given the oftenasymptomatic nature of the arrhythmia and the clear benefit of premorbid interventions including anticoagulation for stroke prevention, it makes intuitive sense that screening for asymptomatic AF would affect outcomes. However, the evidence to support screening remains elusive and is complicated by questions as basic as who to screen, how best to screen, how much AF is actionable, and if we can do more good than harm by finding and treating AF early.It is in this context that the US Preventive Services Task Force (USPSTF) reports that "the current evidence is insufficient to assess the balance of benefits and harms of screening for AF" (I statement). 1 The evidence report and systematic review have also been updated. 2 This conclusion is not a recommendation against screening for AF but indicates that the evidence is insufficient to recommend either for or against screening. It mirrors the 2018 statement on the same topic, but several recent advances bolster both sides of the argument.The USPSTF statement does not currently support electrocardiogram (ECG) screening, but opportunistic screening via pulse palpation at the time of physical examination is recommended by multiple professional organizations in Europe, Canada, and Australia and by the World Heart Federation for those older than 65 years followed by an ECG if pulse irregularity is detected. [3][4][5] By contrast, the USPSTF considers opportunistic screening to be a facilitated case finding rather than actual screening and is considered to be part of routine or usual care.However, studies have not demonstrated a superiority of ECG compared with a thorough physical examination in the context of clinical trials although in usual clinical practice, the examination is infrequently performed, 6 is likely to detect more persistent AF, and can have high false-positive rates owing to ectopy and a high false-negative rate in older individuals owing to intrinsic or iatrogenic slowing of ventricular rates. Two randomized clinical trials of single-time opportunistic singlelead ECG screening in primary care did not find an increased rate of AF detection in the ECG screening practices compared with control practices, with the exception of those 85 years or older in the Screening for Atrial Fibrillation Among Older

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Screening for Atrial Fibrillation

Abstract: AF), the most common arrhythmia, increases the risk of stroke.OBJECTIVE To review the evidence on screening for AF in adults without prior stroke to inform the US Preventive Services Task Force.

Cited by 30 publications

References 54 publications

Screening for Atrial Fibrillation

Screening for Atrial Fibrillation

Screening for Atrial Fibrillation—More Data Still Needed

Updated USPSTF Guidelines for Screening for Atrial Fibrillation

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