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Thromb Haemost 2013; 110(02): 213-222
DOI: 10.1160/TH13-02-0165
Review Article
Schattauer GmbH

Screening to identify unknown atrial fibrillation

A systematic review
Nicole Lowres
1   University of Sydney, ANZAC Research Institute and Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
,
Lis Neubeck
2   The George Institute for Global Health, Sydney, New South Wales, Australia
,
Julie Redfern
2   The George Institute for Global Health, Sydney, New South Wales, Australia
,
S. Ben Freedman
1   University of Sydney, ANZAC Research Institute and Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia
› Author Affiliations Financial support: NL is funded by a National Heart Foundation Postgraduate Scholarship (PP12S6990). LN is funded by an NHMRC early career fellowship (1036763). JR is funded by a Postdoctoral Fellowship co-funded by the NHMRC and National Heart Foundation (632933).
Further Information

Publication History

Received: 24 February 2013

Accepted after minor revision: 21 March 2013

Publication Date:
04 December 2017 (online)

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Summary

Atrial fibrillation (AF) is associated with a significantly increased stroke risk which is highly preventable with appropriate oral anticoagulant therapy (OAC). However, AF may be asymptomatic and unrecognised prior to stroke. We aimed to determine if single time-point screening for AF could identify sufficient numbers with previously undiagnosed AF, to be effective for stroke prevention. This is a systematic review of clinical trials, by searching electronic medical databases, reference lists and grey literature. Studies were included if they evaluated a general ambulant adult population, using electrocardiography or pulse palpation to identify AF. We identified 30 individual studies (n=122,571, mean age 64 years, 54% male) in nine countries. Participants were recruited either from general practitioner and outpatient clinics (12 studies) or population screening/community advertisements (18 studies). Prevalence of AF across all studies was 2.3% (95% CI, 2.2–2.4%), increasing to 4.4% (CI, 4.1–4.6%) in those ≥65 years (16 studies, n= 27,884). Overall incidence of previously unknown AF (14 studies, n=67,772) was 1.0% (CI, 0.89–1.04%), increasing to 1.4% (CI, 1.2–1.6%) in those ≥65 years (8 studies, n= 18,189) in whom screening setting did not influence incidence identified. Of those with previously unknown AF, 67% were at high risk of stroke. Screening can identify 1.4% of the population ≥65 years with previously undiagnosed AF. Many of those identified would be eligible for, and benefit from OAC to prevent stroke. Given this incidence, community AF screening strategies in at risk older age groups could potentially reduce the overall health burden associated with AF.

Keywords

Clinical studies - prevention - stroke/prevention

 

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