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

Description, patients and keywords:
Screening for atrial fibrillation (AF) has gained increased attention in recent years, as early identification of the condition may lead to prevention of AF-related strokes, reduction of the burden of stroke (1) and associated costs to the health system.(2)

Screening strategies

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 heart’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.

Mechanism

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.

This report is work in progress and should not be used for external distribution without permission from the originating agency. Users should be aware that reports are based on information available at the time of research and often on a limited literature search.