Effectiveness of screening for atrial fibrillation and its determinants. A meta-analysis

Petryszyn, Pawel, Niewinski, Piotr, Staniak, Aleksandra, Piotrowski, Patryk, Well, Anna, Well, Michal, Jeskowiak, Izabela, Lip, Gregory ORCID: 0000-0002-7566-1626 and Ponikowski, Piotr (2019) Effectiveness of screening for atrial fibrillation and its determinants. A meta-analysis. PLOS ONE, 14 (3). e0213198-.

Access the full-text of this item by clicking on the Open Access link.

Text
Effectiveness of screening for atrial fibrillation and its determinants. A meta-analysis.pdf - Published version
Download (2MB) | Preview

Official URL: http://dx.doi.org/10.1371/journal.pone.0213198

Abstract

<h4>Background</h4>Many atrial fibrillation patients eligible for oral anticoagulants are unaware of the presence of AF, and improved detection is necessary to facilitate thromboprophylaxis against stroke.<h4>Objective</h4>To assess the effectiveness of screening for AF compared to no screening and to compare efficacy outcomes of different screening strategies.<h4>Materials and methods</h4>Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE from Jan 1, 2000 -Dec 31, 2015 were searched. Studies employing systematic or opportunistic screening and using ECG or pulse palpation in populations age ≥40 years were included. Data describing study and patient characteristics and number of patients with new AF were extracted. The outcome was the incidence of previously undiagnosed AF.<h4>Results</h4>We identified 25 unique (3 RCTs and 22 observational) studies (n = 88 786) from 14 countries. The incidence of newly detected AF due to screening was 1.5% (95% CI 1.1 to 1.8%). Systematic screening was more effective than opportunistic: 1.8% (95% CI 1.4 to 2.3%) vs. 1.1% (95% CI 0.6 to 1.6%), p<0.05, GP-led screening than community based: 1.9% (95% CI 1.4 to 2.4%) vs. 1.1% (95% CI 0.7 to 1.6%), p<0.05, and repeated heart rhythm measurements than isolated assessments of rhythm: 2.1% (95% CI 1.5-2.8) vs. 1.2% (95% CI 0.8-1.6), p<0.05. Only heart rhythm measurement frequency had statistical significance in a multivariate meta-regression model (p<0.05).<h4>Conclusions</h4>Active screening for AF, whether systematic or opportunistic, is effective beginning from 40 years of age. The organisation of screening process may be more important than technical solutions used for heart rhythm assessment.

Item Type:	Article
Uncontrolled Keywords:	Humans, Atrial Fibrillation, Electrocardiography, Pulse, Mass Screening, Early Diagnosis, Age Factors, Adult, Female, Male, Randomized Controlled Trials as Topic, Observational Studies as Topic
Depositing User:	Symplectic Admin
Date Deposited:	14 May 2019 09:30
Last Modified:	19 Jan 2023 00:46
DOI:	10.1371/journal.pone.0213198
Open Access URL:	https://doi.org/10.1371/journal.pone.0213198
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3041220