Date Added: 10/06/2015
Date Updated: 10/06/2015
Atrial Fibrillation screening to identify those at risk of stroke
Specialties: Cardiovascular disease & vascular surgery
Technology Type: Programmes
Stage of development: Established
Stage of EAA: Assessment Complete
There are different types of screening strategies for the detection of new cases of AF including systematic, opportunistic and targeted screening. Systematic screening programs involve offering screening to everyone in a particular population without a prior diagnosis of AF, whilst opportunistic screening usually involves screening those that present for a routine consultation and targeted screening only offers screening to people at high risk of AF. Current guidelines from the European Society of Cardiology (3) for the management of AF recommend opportunistic screening for people aged 65 years and over.
Methods of testing
The gold standard test to diagnose AF is the 12-lead electrocardiograph (ECG), interpreted by a cardiologist.(2) The 12-lead ECG is often employed in systematic screening programs for AF. Opportunistic screening for AF as outlined by the European Society of Cardiology guidelines consisted of pulse palpation followed a referral for a 12-lead ECG, when irregularities are detected.(3) Pulse palpation is an easy method of assessing the heartâ€™s rate and rhythm, however, it cannot be used to detect the presence of AF on its own.(4) Opportunistic screening, using a single 12-lead ECG may not detect paroxysmal AF, and repeated ECGs or a continuous ambulatory ECG monitor may be required.
AF can remain undetected in the general adult population for many reasons including being asymptomatic,(5) presenting with atypical symptomatology,(6) or symptomatic patients failing to present to their general practitioner or not accurately attributing their symptoms to AF.(7) Therefore, screening for AF may lead to an increase in the diagnosis of AF and subsequent detection of those who would benefit from oral antiplatelet or anticoagulant prophylaxis prior to the occurrence of symptoms,(1) thereby reducing the incidence of AF-related strokes.
This report will review the evidence and examine the effectiveness, cost-effectiveness and appropriateness of a screening program for AF in Australia. It will also explore the clinical benefits and risks associated with prophylactic treatment to avoid bias associated with screening for AF.