Atrial fibrillation: is there enough evidence to recommend opportunistic or systematic screening?

Orchard, Jessica; Lowres, Nicole; Neubeck, Lis; Freedman, Ben

Abstract

Atrial fibrillation (AF) is the most common heart arrhythmia, the prevalence rising with age to 18% for those aged  ≥85 years. It is associated with a 5-fold higher likelihood of stroke, a doubling of mortality and an increased likelihood of heart failure, myocardial infarction and dementia.
It is estimated that 1.6% of the population aged  ≥65 have undiagnosed, largely asymptomatic AF. For those diagnosed with AF, treatment with appropriate oral anticoagulant (OAC) therapy can reduce stroke by 64% [95% confidence interval (CI): 49%–74%] and all-cause mortality by 26% (95% CI: 3%–43%). Guidelines recommend treatment for those with one or more additional risk factors for stroke as set out in the universally accepted CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age and Diabetes). In addition, a recent study suggested that early OAC treatment reduces subsequent dementia.

• Journal Article Type: Review
• Acceptance Date: May 25, 2018
• Online Publication Date: Jun 21, 2018
• Publication Date: Oct 1, 2018
• Deposit Date: Dec 3, 2018
• Journal: International Journal of Epidemiology
• Print ISSN: 0300-5771
• Electronic ISSN: 1464-3685
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 47
• Issue: 5
• Pages: 1372-1378
• DOI: https://doi.org/10.1093/ije/dyy111
• Keywords: Atrial fibrillation, heart arrhythmia, stroke, mortality, screening,
• Public URL: http://researchrepository.napier.ac.uk/Output/1182509