Evidence suggests that systematic screening and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice .
Although these approaches have comparable effects on the overall AF diagnosis rate , the cost of systematic screening is significantly greater than the cost of opportunistic screening from the perspective of the health service provider .
BACKGROUND Atrial fibrillation ( AF ) , the most common arrhythmia in clinical practice , 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 before the onset of symptoms .
However , for screening to be an effective intervention , it must improve the detection of AF and provide benefit for those detected earlier as a result of screening .
OBJECTIVES This review aims to answer the following questions .Does systematic screening increase the detection of AF compared with routine practice ?
Which combination of screening population , strategy and test is most effective for detecting AF compared with routine practice ?
What safety issues and adverse events may be associated with individual screening programmes ?
How acceptable is the intervention to the target population ?
What costs are associated with systematic screening for AF ?
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
Evidence suggests that systematic screening and opportunistic screening for AF increase the rate of detection of new cases compared with routine practice .
Although these approaches have comparable effects on the overall AF diagnosis rate , the cost of systematic screening is significantly greater than the cost of opportunistic screening from the perspective of the health service provider .
BACKGROUND Atrial fibrillation ( AF ) , the most common arrhythmia in clinical practice , 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 before the onset of symptoms .
However , for screening to be an effective intervention , it must improve the detection of AF and provide benefit for those detected earlier as a result of screening .
OBJECTIVES This review aims to answer the following questions .Does systematic screening increase the detection of AF compared with routine practice ?
Which combination of screening population , strategy and test is most effective for detecting AF compared with routine practice ?
What safety issues and adverse events may be associated with individual screening programmes ?
How acceptable is the intervention to the target population ?
What costs are associated with systematic screening for AF ?