Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation Statement
- PMID: 30088016
- DOI: 10.1001/jama.2018.10321
Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation Statement
Abstract
Importance: Atrial fibrillation is the most common type of cardiac arrhythmia (irregular heartbeat), and its prevalence increases with age, affecting about 3% of men and 2% of women aged 65 to 69 years and about 10% of adults 85 years and older. Atrial fibrillation is a major risk factor for ischemic stroke, increasing risk of stroke by as much as 5-fold. Approximately 20% of patients who have a stroke associated with atrial fibrillation are first diagnosed with atrial fibrillation at the time of stroke or shortly thereafter.
Objective: To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation with electrocardiography (ECG).
Evidence review: The USPSTF reviewed the evidence on the benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older, the effectiveness of screening with ECG for detecting previously undiagnosed atrial fibrillation compared with usual care, and the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected atrial fibrillation in older adults.
Findings: Most older adults with previously undiagnosed atrial fibrillation have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment. Anticoagulant therapy is effective for stroke prevention in symptomatic persons with atrial fibrillation and high stroke risk. However, the USPSTF found inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established and include misdiagnosis and invasive testing. Given these uncertainties, it is not possible to determine the net benefit of screening with ECG.
Conclusions and recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement).
Comment in
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Electrocardiographic Monitoring for Prevention of Atrial Fibrillation-Associated Cardioembolic Stroke.JAMA. 2018 Aug 7;320(5):447-449. doi: 10.1001/jama.2018.9185. JAMA. 2018. PMID: 30087990 No abstract available.
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Electrocardiography Screening for Atrial Fibrillation.JAMA. 2018 Dec 25;320(24):2598. doi: 10.1001/jama.2018.17764. JAMA. 2018. PMID: 30575869 No abstract available.
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Direct-to-Consumer Atrial Fibrillation Screening.JAMA Intern Med. 2019 Jan 1;179(1):121-122. doi: 10.1001/jamainternmed.2018.6972. JAMA Intern Med. 2019. PMID: 30615080 No abstract available.
Summary for patients in
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Screening for Atrial Fibrillation With Electrocardiography.JAMA. 2018 Aug 7;320(5):516. doi: 10.1001/jama.2018.10598. JAMA. 2018. PMID: 30088011 No abstract available.
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