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screening for atrial fibrillation

Procedure: - palpating pulse for irregularly irregular rhythm - most cost effective approach to detect atrial fibrillation - follow-up electrocardiogram if not regular rate & rhythm [1,2] - screening with electrocardiogram not indicated (USPSTF) [3] - 14 day monitor, event recorder (ZeoPatch) Clinical significance: - screening elderly >=75 years with hypertension, thus minimal CHADS2-VASC score of 3, yields 5% with atrial fibrillation vs 0.5% if discovered without screening [4] - clinical benefit is unclear [4] - USPSTF concludes evidence is insufficient to recommend for or against screening [4,5] - screening for atrial fibrillation in primary care with a single hand-held ECG of no benefit [6] - 14 day monitor improves recognition of atrial fibrillation lasting > 30 seconds but does not reduced risk of hospitalization for stroke [7]

Related

atrial fibrillation (AF)

General

screening for heart disease

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  2. Fitzmaurice DA, Hobbs FD, Jowett S et al Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ. 2007 Aug 25;335(7616):383. Epub 2007 Aug 2. PMID: 17673732 Free PMC Article
  3. Draft Recommendation Statement. Dec 2017 Atrial Fibrillation: Screening With Electrocardiography https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/atrial-fibrillation-screening-with-electrocardiography - Draft Evidence Review. Dec 2017 Draft Evidence Review for Atrial Fibrillation: Screening With Electrocardiography. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/atrial-fibrillation-screening-with-electrocardiography - Curry SJ et al. Screening for atrial fibrillation with electrocardiography: US Preventive Services Task Force recommendation statement. JAMA 2018 Aug 7; 320:478. PMID: 30088016 https://jamanetwork.com/journals/jama/fullarticle/2695678 - Jonas DE et al. Screening for atrial fibrillation with electrocardiography: Evidence report and systematic review for the US Preventive Services Task Force. JAMA 2018 Aug 7; 320:485. PMID: 30088015 https://jamanetwork.com/journals/jama/fullarticle/2695677 - Goldberger JJ, Mitrani RD. Electrocardiographic monitoring for prevention of atrial fibrillation-associated cardioembolic stroke. JAMA 2018 Aug 7; 320:447. PMID: 30087990 https://jamanetwork.com/journals/jama/fullarticle/2695650 - US Preventive Services Task Force (USPSTF) Screening for Atrial Fibrillation Draft Recommendation Statement, April 20, 2021 https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/screening-atrial-fibrillation - Draft Recommendation Review, April 20, 2021 https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/screening-atrial-fibrillation
  4. Gladstone DJ, Wachter R, Schmalstieg-Bahr K et al. Screening for atrial fibrillation in the older population: A randomized clinical trial. JAMA Cardiol 2021 Feb 24; [e-pub] PMID: 33625468 PMCID: PMC7905702 (available on 2022-02-24) https://jamanetwork.com/journals/jamacardiology/article-abstract/2776728
  5. US Preventive Services Task Force Screening for Atrial Fibrillation. US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(4):360-367 PMID: 35076659 https://jamanetwork.com/journals/jama/fullarticle/2788340 - Kahwati LC, Asher GN, Kadro ZO et al Screening for Atrial Fibrillation. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2022;327(4):368-383 PMID: 35076660 https://jamanetwork.com/journals/jama/fullarticle/2788341 - Greenland P Screening for Atrial Fibrillation - More Data Still Needed JAMA. 2022;327(4):329-330 PMID: 35076684 https://jamanetwork.com/journals/jama/fullarticle/2788368 - Kalscheur MM, Goldberger ZD Screening for Atrial Fibrillation - Refining the Target. JAMA Netw Open. 2022;5(1):e2139910 PMID: 35076707 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788386 - Passman R, Freedman B. Updated USPSTF Guidelines for Screening for Atrial Fibrillation. Same as It Ever Was? JAMA Cardiol. Published online January 25, 2022. PMID: 35076686 https://jamanetwork.com/journals/jamacardiology/fullarticle/2788234 - Phen C USPSTF Not Backing Afib Screening, Even With Wearables. Experts agree but see no stopping it. MedPage Today January 25, 2022 https://www.medpagetoday.com/cardiology/arrhythmias/96842
  6. Lubitz SA, Atlas SJ, Ashburner JM et al. Screening for atrial fibrillation in older adults at primary care visits: The VITAL-AF randomized controlled trial. Circulation 2022 Mar 2 PMID: 3523221 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057014
  7. Lopes RD, Atlas SJ, Go AS et al. Effect of screening for undiagnosed atrial fibrillation on stroke prevention. J Am Coll Cardiol. 2024 Aug 29:S0735-1097(24)08174-9 PMID: 39230544 https://www.sciencedirect.com/science/article/abs/pii/S0735109724081749