Systematic and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice .
While both approaches have a comparable effect on the overall AF diagnosis rate , the cost of systematic screening is significantly more than that of opportunistic screening from the perspective of the health service provider .
BACKGROUND Atrial fibrillation ( AF ) is the most common arrhythmia in clinical practice and is a leading cause of morbidity and mortality .
Screening for AF in asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy prior to the onset of symptoms .
However , for screening to be an effective intervention it must improve the detection of AF and provide benefit for those who are detected earlier as a result of screening .
OBJECTIVES The primary objective of this review was to examine whether screening programmes increase the detection of new cases of AF compared to routine practice .
The secondary objectives were to identify which combination of screening strategy and patient population is most effective , as well as assessing any safety issues associated with screening , its acceptability within the target population and the costs involved .
The additional value of routine electrocardiograms in cardiovascular risk management of older people
Objective . To evaluate whether routinely performed ECGs in older people from the general population have added value for cardiovascular risk management beyond the information that is already available from their medical records . Design . Observational , prospect i ve cohort study . Setting . General population . Subjects . A total of 566 participants aged 85 years ( 377 women , 189 men ) . Methods . Lifelong history of cardiovascular disease was assessed through medical records obtained from general practitioners . Baseline ECGs were evaluated for prior myocardial infa rct ion and atrial fibrillation . During a 5-year follow-up period , complete cardiovascular mortality and morbidity data were gathered . Results . During 5 years of follow-up , 262/566 ( 46 % ) participants died , of whom 102/262 ( 39 % ) died from cardiovascular disease . Participants with a history of cardiovascular disease at age 85 years ( 284/566 , 50 % ) had an increased cardiovascular mortality ( HR 2.7 , 95 % CI 1.8–4.1 ) and morbidity ( HR myocardial infa rct ion 2.1 , 95 % CI 1.3–3.6 ; HR stroke 2.7 , 95 % CI 1.6–4.9 ) compared with those without such a history . Participants with major ECG abnormalities ( 102/566 , 18 % ) had an increased cardiovascular mortality ( HR 1.8 , 95 % CI 1.1–2.8 ) , but no increase of cardiovascular morbidity compared with those without major ECG abnormalities . In both participants with and without a history of cardiovascular disease , the presence of major ECG abnormalities was not associated with increased cardiovascular mortality or morbidity . Conclusions . In older people from the general population , a history of cardiovascular disease is a strong predictor of cardiovascular mortality and morbidity . Although abnormal findings on routine ECGs predict cardiovascular mortality , they do not provide additional prognostic information beyond the information available from medical records . Therefore , when accurate medical records are available , programmatic ECG recording is not effective in older people
Systematic and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice .
While both approaches have a comparable effect on the overall AF diagnosis rate , the cost of systematic screening is significantly more than that of opportunistic screening from the perspective of the health service provider .
BACKGROUND Atrial fibrillation ( AF ) is the most common arrhythmia in clinical practice and is a leading cause of morbidity and mortality .
Screening for AF in asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy prior to the onset of symptoms .
However , for screening to be an effective intervention it must improve the detection of AF and provide benefit for those who are detected earlier as a result of screening .
OBJECTIVES The primary objective of this review was to examine whether screening programmes increase the detection of new cases of AF compared to routine practice .
The secondary objectives were to identify which combination of screening strategy and patient population is most effective , as well as assessing any safety issues associated with screening , its acceptability within the target population and the costs involved .