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 .
Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry.
OBJECTIVE Atrial fibrillation is often asymptomatic , but outcomes require further characterization . The study objective was to investigate the clinical presentation , management , and outcomes in asymptomatic and symptomatic patients with atrial fibrillation who were prospect ively enrolled in the EurObservational Research Programme - Atrial Fibrillation ( EORP-AF ) Pilot General Registry . METHODS A total of 3119 patients were enrolled , and 1237 ( 39.7 % ) were asymptomatic ( European Heart Rhythm Association [ EHRA ] score I ) . Among symptomatic patients , 963 ( 51.2 % ) had mild symptoms ( EHRA score II ) and 919 ( 48.8 % ) had severe or disabling symptoms ( EHRA III-IV ) . Permanent atrial fibrillation was 3-fold more common in asymptomatic patients than in symptomatic patients . RESULTS On multivariate analysis , male gender ( odds ratio [ OR ] , 1.630 ; 95 % confidence interval [ CI ] , 1.384 - 1.921 ) , older age ( OR , 1.019 ; 95 % CI , 1.012 - 1.026 ) , previous myocardial infa rct ion ( OR , 1.681 ; 95 % CI , 1.350 - 2.093 ) , and limited physical activity ( OR , 1.757 ; 95 % CI , 1.495 - 2.064 ) were associated significantly with asymptomatic ( EHRA I ) atrial fibrillation . Fully asymptomatic atrial fibrillation ( absence of current and previous symptoms ) was present in 520 patients ( 16.7 % ) and was associated independently with male gender , age , and previous myocardial infa rct ion . Appropriate guideline -based prescription of oral anticoagulants  was lower in these patients , and  aspirin  was prescribed more frequently . Mortality at 1 year was more than 2-fold higher in asymptomatic patients compared with symptomatic patients ( 9.4 % vs 4.2 % , P < .0001 ) and was associated independently with older age and comorbidities , including chronic kidney disease and chronic heart failure . CONCLUSIONS Asymptomatic atrial fibrillation is common in daily cardiology practice and is associated with elderly age , more comorbidities , and high thromboembolic risks . A higher 1-year mortality was found in asymptomatic patients compared with symptomatic patients
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 .