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
