Screening for Atrial Fibrillation - A Report of the AF-SCREEN International Collaboration

Research output: Contribution to journalArticle

Authors

  • S Ben Freedman
  • A John Camm
  • Hugh Calkins
  • Jeffrey S Healey
  • Mårten Rosenqvist
  • Jiguang Wang
  • Giuseppe Boriani
  • Craig S Anderson
  • Sotiris Antoniou
  • Emelia Benjamin
  • Christine M. Albert
  • Johannes Brachmann
  • Axel Brandes
  • Tze-Fan Chao
  • David Conen
  • Johan Engdahl
  • Laurent Fauchier,
  • David Fitzmaurice
  • Leif Friberg
  • Bernard J. Gersh
  • Taya V Glotzer
  • Kylie MA Gwynne
  • Graeme J Hankey
  • Joseph Harbison
  • Graham S Hillis
  • Hooman Kamel
  • David J. Gladstone,
  • Mellanie T Hills
  • Peter R. Kowey
  • Derk Krieger,
  • Vivian W. Y. Lee
  • Lars-Ake Levin
  • Trudie Lobban
  • Nicole Lowres
  • Georges H Mairesse
  • Carlos Martinez
  • Lis Neubeck
  • Jessica Orchard
  • Jonathan P Piccini,
  • Katrina Poppe
  • Helmut Puererfellner
  • Tatjana S. Potpara
  • Michiel Rienstra
  • Roopinder K Sandhu
  • Renate B Schnabel
  • Chung-Wah Siu
  • Steven Steinhubl
  • Jesper H. Svendsen
  • Emma Svennberg
  • Sakis Themistoclakis
  • Robert G Tieleman
  • Mintu P Turakhia
  • Arnljot Tveit
  • Steven B Uittenbogaart
  • Gelder Van
  • Isabelle C
  • Atul Verma
  • Rolf Wachter
  • Yan Bryan P

Colleges, School and Institutes

Abstract

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

Details

Original languageEnglish
Pages (from-to)1851-1867
JournalCirculation
Volume135
Issue number19
Early online date9 May 2017
Publication statusE-pub ahead of print - 9 May 2017

Keywords

  • atrial fibrillation, screening, stroke