Conclusions and Relevance Although screening with ECG can detect previously unknown cases of atrial fibrillation , it has not been shown to detect more cases than screening focused on pulse palpation .
Treatments for atrial fibrillation reduce the risk of stroke and all-cause mortality and increase the risk of bleeding , but trials have not assessed whether treatment of screen-detected asymptomatic older adults results in better health outcomes than treatment after detection by usual care or after symptoms develop
Importance Atrial fibrillation is the most common arrhythmia and increases the risk of stroke .
Objective To review the evidence on screening for nonvalvular atrial fibrillation with electrocardiography ( ECG ) and stroke prevention treatment in asymptomatic adults 65 years or older to inform the US Preventive Services Task Force .
Anticoagulant prophylaxis against stroke in atrial fibrillation: effectiveness in actual practice.
BACKGROUND R and omized trials have shown a beneficial effect of anticoagulation with warfarin to prevent stroke in atrial fibrillation . It is not known whether the same effect will be obtained in actual practice . The authors conducted a prospect i ve observational study to evaluate the effect of preventive anticoagulation in patients with atrial fibrillation in 2 practice setting s in Montreal . METHODS Of the 1725 out patients screened between October 1990 and September 1993 at a community hospital and a university-affiliated hospital , 221 with documented atrial fibrillation were enrolled and followed up for a mean of 27 months . Most ( 75 % ) of the patients excluded did not meet the inclusion criteria ( because of , for example , an artificial heart valve , mitral stenosis , cardiac transplantation or transient atrial fibrillation ) ; the remainder had not completed enrollment before the end of the study . Following the baseline visit , patients were interviewed by telephone every 6 months , and reported events were confirmed through review of the patients ' charts . Hazards for stroke and for stroke and transient ischemic attack ( TIA ) combined were calculated for each of 4 treatment groups : ASA , warfarin , blended treatment and no treatment , based on the type of anticoagulation therapy patients received during the entire observation period . The blended-treatment group consisted of patients who started on one active therapy and switched to the other or who switched treatments more than once . Corresponding rate ratios ( RRs ) and 95 % confidence intervals ( CIs ) were calculated with reference to the no-treatment group . Cox proportional hazards analysis was used to adjust for differences in patient characteristics . The rates of bleeding episodes were also analysed . RESULTS On average , the study patients were older ( 71.6 [ st and ard deviation 9.3 ] years ) and had a higher prevalence of underlying heart disease ( 52.0 % ) than those in the r and omized trials . Nineteen patients had a first stroke : 4 in the ASA group , 4 in the warfarin group , 4 in the blended-treatment group and 7 in the no-treatment group , for rates of 5.2 , 1.8 , 5.3 and 5.9 per 100 person-years , respectively . Only warfarin was associated with a significantly lower risk of stroke compared with no anticoagulant therapy ( RR 0.31 , 95 % CI 0.09 - 1.00 ) . A similar protective effect of warfarin was found for stroke and TIA combined ( 2.3 v. 6.7 per 100 person-years ; RR 0.34 , 95 % CI 0.12 - 0.99 ) ; the effect of ASA and blended treatment was not significantly different from no treatment . The rate per 100 person-years of any bleeding was not significantly higher for any treatment group ( ASA 2.5 , warfarin 3.4 and blended treatment 3.5 ) compared with the no-treatment group ( 1.9 ) . Patients receiving warfarin had a significantly greater risk of any bleeding event than patients not receiving anticoagulant therapy ( RR 1.79 , 95 % CI 1.07 - 3.00 ) . INTERPRETATION The relative effect of anticoagulant therapy with warfarin in preventing stroke in these practice setting s was equivalent to that in the r and omized trials , although these patients were older and sicker . This preventive treatment is likely to confer additional benefit as it is more widely prescribed
Conclusions and Relevance Although screening with ECG can detect previously unknown cases of atrial fibrillation , it has not been shown to detect more cases than screening focused on pulse palpation .
Treatments for atrial fibrillation reduce the risk of stroke and all-cause mortality and increase the risk of bleeding , but trials have not assessed whether treatment of screen-detected asymptomatic older adults results in better health outcomes than treatment after detection by usual care or after symptoms develop
Importance Atrial fibrillation is the most common arrhythmia and increases the risk of stroke .
Objective To review the evidence on screening for nonvalvular atrial fibrillation with electrocardiography ( ECG ) and stroke prevention treatment in asymptomatic adults 65 years or older to inform the US Preventive Services Task Force .