Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and prevalence is predicted to double over the next 30 years due to changing demographics and the rise in prevalence of risk factors such as hypertension and diabetes. Atrial fibrillation is associated with a five-fold increased stroke risk, but anticoagulation in eligible patients can reduce this risk by around 65%. Many people with AF currently go undetected and therefore untreated, either because they are asymptomatic or because they have paroxysmal AF. Screening has been suggested as one approach to increase AF detection rates and reduce the incidence of ischaemic stroke by earlier initiation of anticoagulation therapy. However, international taskforces currently recommend against screening, citing the cost implications and uncertainty over the benefits of a systematic screening programme compared to usual care. A number of large randomized controlled trials have commenced to determine the cost-effectiveness and clinical benefit of screening using a range of devices and across different populations. The recent AppleWatch study demonstrates how advances in technology are providing the public with self-screening devices that are increasingly affordable and accessible. Health care professionals should be aware of the implications of these emerging data for diagnostic pathways and treatment. This review provides an overview of the gaps in the current evidence and a summary of the arguments for and against screening.
| Original language | English |
|---|---|
| Pages (from-to) | 1075-1085 |
| Number of pages | 11 |
| Journal | European Heart Journal |
| Volume | 41 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 7 Mar 2020 |
Bibliographical note
Funding Information:Conflict of interest: B.C., L.B., and N.R.J. are part of the trial team for the AMALFI AF screening study, funded by the NIHR Oxford BRC and iRhythm Technology Inc. B.C. is the Principal Investigator of a BHF-funded AF screening study within UK Biobank. B.C. acknowledges non-financial support from Roche Diagnostics outside the submitted work. L.B. acknowledges financial support in the form of research grants to the University of Oxford from the British Heart Foundation, UK Medical Research Council, Merck and The Medicines Company outside the submitted work. F.D.R.H. is co-Principal Investigator on the SAFER AF Screening Trial, funded by the NIHR. C.J.T. reports speaker fees from Vifor and Novartis and non-financial support from Roche outside of the submitted work.
Funding Information:
N.R.J. is supported by a Wellcome Trust Doctoral Research Fellowship (203921/Z/16/Z). C.J.T. is funded through a National Institute for Health Research (NIHR) Academic Clinical Lectureship. F.D.R.H. acknowledges his part-funding from the NIHR School for Primary Care Research, the NIHR Collaboration for Leadership in Health Research and Care (CLARHC) Oxford, the NIHR Oxford Biomedical Research Centre (BRC), and the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative. L.B. acknowledges funding from the British Heart Foundation (BHF), UK Medical Research Council and the NIHR Oxford BRC. B.C. acknowledges funding from the BHF and the NIHR Oxford BRC. The views expressed are those of the authors and not necessarily those of the NHS, the BHF, the NIHR, or the Department of Health and Social Care.
Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
Keywords
- Anticoagulation
- Atrial fibrillation
- Screening
- Stroke
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
