Stepwise Screening of Atrial Fibrillation in a 75-Year Old Population: Implications for Stroke Prevention
Background—Atrial fibrillation (AF) is a frequent source of cardiac emboli in patients with ischemic stroke. AF may be asymptomatic and therefore undiagnosed. Screening for silent AF seems suitable in risk populations, little is however known on the yield and cost-effectiveness of such screening.
Methods and Results—All inhabitants in the municipality of Halmstad, Sweden age 75-76 were invited to a stepwise screening program for AF. As a first step, participants recorded a 12-lead ECG and reported their relevant medical history. Those with sinus rhythm on 12-lead ECG, no history of AF and at least two risk factors according to CHADS2 were invited to a 2 week recording period using a hand-held ECG asked to record 20 or 30 seconds twice daily and if palpitations occurred. 1330 inhabitants were invited of whom 848 (64%) participated. Previously undiagnosed silent AF was found in 10 (1%) among 848 individuals who recorded 12-lead ECG. Among 81 patients with known AF, 35 (43%) were not on OAC treatment. Among 403 persons with at least two risk factors for stroke, who completed the hand-held ECG event recording, 30 (7.4%) were diagnosed with paroxysmal AF. Thus 75/848 (9%) of the screened population were candidates for new OAC treatment, of those 57 actually started OAC treatment.
Conclusions—Stepwise risk factor-stratified AF screening in a 75-year old population yields a large share of candidates for OAC treatment on AF indication.
- Received June 26, 2012.
- Accepted December 27, 2012.
- Copyright © 2013, Circulation