Pooled yield of screening was greater in males across all age strata .
Neither the choice of screening methodology or device , the geographical region , nor the screening setting influenced the detection rate of AF .
The main limitation of this study is there are insufficient data on sociodemographic variables of the population s and possible ascertainment biases to explain the variance in the sample s. CONCLUSIONS People with screen-detected AF are at elevated calculated stroke risk : above age 65 , the majority have a Class-1 OAC recommendation for stroke prevention , and > 70 % have ≥1 additional stroke risk factor other than age/sex .
BACKGROUND The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation ( AF ) is not known .
Therefore , it is not possible to determine the number needed to screen ( NNS ) to identify one treatable new AF case ( NNS-Rx ) ( i.e. , Class-1 oral anticoagulation [ OAC ] treatment recommendation ) in each age stratum .
If the NNS-Rx is known for each age stratum , precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population /region to be screened .
Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded .
Therefore , we aim ed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata .
Major progress in anticoagulant uptake for atrial fibrillation at last: does it translate into stroke prevention?
A number of r and omized controlled trials in atrial fibrillation ( AF ) conducted in the last century showed that vitamin K antagonists , ( VKAs ) , principally warfarin , were remarkably effective in stroke prevention , reducing stroke by 64 % and all-cause mortality by 26 % , figures rarely matched in treatments of other diseases . With the introduction of the non-VKA anticoagulants ( NOACs ) in the last 8 years , stroke reduction in the r and omized trials was similar to VKAs , but with less intracranial haemorrhage and a further 1 % absolute risk reduction in total mortality ; results confirmed in many ‘ real-life ’ studies using administrative or registry data . Many guidelines , including the first joint AHA/ACC/ESC guideline in 2001 , recommended oral anticoagulant ( OAC ) therapy for those with AF at elevated risk of stroke , as have subsequent joint and ESC guidelines and up date s in 2006 , 2010 , 2012 , and 2016 . But OAC uptake has been less than ideal for some time , hovering in the UK at 50 % of those for whom OAC was guideline recommended , in the 10 years from 2001 to 2011 . The data from the Swedish RIKS registry of > 94 000 strokes help identify the two major gaps in prevention of AF-related strokes , which represent 33 % of all ischaemic strokes ( Take home figure ) . In 9 % of all strokes , AF was not known prior to stroke : prevention would require screening to detect and treat unknown AF . In another 20 % , AF was known but patients were either on no antithrombotic therapy ( 8 % ) or on antiplatelet therapy alone ( 12 % ) , which is largely ineffective for AF thrombo-prophylaxis . Thus , up to 20 % of ischaemic strokes might be prevented if the evidence – practice gap of OAC prescription was eliminated . It is therefore very pleasing to see in this issue of the European Heart Journal that in the UK ,  OAC use in patients with elevated stroke risk  has increased from < 50 % to almost 80 % in the 10 years from 2006 to 2016 , mostly in the latter 5 years , while  antiplatelet therapy  has reduced from 43 % to 16 % . This is a great success story , observed to some degree in many countries , but by no means uniformly , even within the same country . Trying to pinpoint the reason for this improvement is not easy . Success has many fathers , while failure is an orphan . Cowan and colleagues postulate that successive ESC and NICE guidelines , quality improvement incentivization programmes such as GRASP and QOF , or licensing and marketing of NOACs , accentuating their ease of use , could all have played a role , but it is difficult to determine which is the major one . ESC guidelines and their up date s were recommending OAC in 2001 , 2006 , and 2010 , and the GRASP quality initiative from 2009 , with little change in OAC uptake , while QOF did not commence until 2012 . It is instructive to look at our own UK data using a higher resolution temporal trend of OAC initiation within 90 days of incident AF ( Figure 1 ) . The graph plots total OAC initiations for patients with CHA2DS2-VASc > _ 2 . A rise in VKA OAC prescription was observed from early 2011 , when limited marketing preceded the availability of NOAC drugs , followed by an accentuated increase due to NOAC prescription accompanied by a plateau in VKA prescription . It is quite likely that at this time point , the availability and marketing of NOACs played a dominant role , with this influence increasing as additional NOACs became available . The final increase from 2013 to 2106 is probably a combination of all three factors : an effective national QOF quality framework , gradual percolation of guidelines and up date s , and continued marketing of NOACs . Ensuring that a high proportion of patients with AF are taking effective doses of OAC rather than aspirin requires first that OAC is offered by the physician and accepted by the patient , secondly that patients are adherent to taking the drugs as prescribed , achieving > 70 % time in the therapeutic international normalized ratio ( INR ) range for VKAs , and finally , that patients persist with taking  OAC therapy long-term . There is a high non-persistence rate for OAC in the first 2 years after initiation , significantly greater for VKAs than
Pooled yield of screening was greater in males across all age strata .
Neither the choice of screening methodology or device , the geographical region , nor the screening setting influenced the detection rate of AF .
The main limitation of this study is there are insufficient data on sociodemographic variables of the population s and possible ascertainment biases to explain the variance in the sample s. CONCLUSIONS People with screen-detected AF are at elevated calculated stroke risk : above age 65 , the majority have a Class-1 OAC recommendation for stroke prevention , and > 70 % have ≥1 additional stroke risk factor other than age/sex .
BACKGROUND The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation ( AF ) is not known .
Therefore , it is not possible to determine the number needed to screen ( NNS ) to identify one treatable new AF case ( NNS-Rx ) ( i.e. , Class-1 oral anticoagulation [ OAC ] treatment recommendation ) in each age stratum .
If the NNS-Rx is known for each age stratum , precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population /region to be screened .
Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded .
Therefore , we aim ed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata .