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 .
Low-dose aspirin for prevention of stroke in low-risk patients with atrial fibrillation: Japan Atrial Fibrillation Stroke Trial.
BACKGROUND AND PURPOSE Although the efficacy of anticoagulant therapy for primary prevention of stroke in patients with nonvalvular atrial fibrillation ( NVAF ) has been established , efficacy of antiplatelet therapy for low-risk patients is disputable in Japanese patients because of the frequent hemorrhagic complications . We examined the efficacy and safety of aspirin therapy in Japanese patients with NVAF in a prospect i ve r and omized multicenter trial . METHODS Patients with NVAF were r and omized to an aspirin group ( aspirin at 150 to 200 mg per day ) or a control group without antiplatelet or anticoagulant therapy . Primary end points included cardiovascular death , symptomatic brain infa rct ion , or transient ischemic attack . RESULTS A total of 426 patients were r and omized to aspirin group and 445 to no treatment . The trial was stopped earlier because there were 27 primary end point events ( 3.1 % per year ; 95 % CI , 2.1 % to 4.6 % per year ) in the aspirin group versus 23 ( 2.4 % per year ; 95 % CI , 1.5 % to 3.5 % per year ) in the control group , suggesting a low possibility of superiority of the aspirin treatment for prevention of the primary end point . In addition , treatment with aspirin caused a marginally increased risk of major bleeding ( 7 patients ; 1.6 % ) compared with the control group ( 2 patients ; 0.4 % ; Fisher exact test P=0.101 ) . CONCLUSIONS For prevention of stroke in patients with NVAF , aspirin at 150 to 200 mg per day does not seem to be either effective or safe . Further prospect i ve studies are needed to determine the best preventive therapy for cerebrovascular events in Japanese patients with NVAF
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 .