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 .
Lenient versus strict rate control in patients with atrial fibrillation.
BACKGROUND Rate control is often the therapy of choice for atrial fibrillation . Guidelines recommend strict rate control , but this is not based on clinical evidence . We hypothesized that lenient rate control is not inferior to strict rate control for preventing cardiovascular morbidity and mortality in patients with permanent atrial fibrillation . METHODS We r and omly assigned 614 patients with permanent atrial fibrillation to undergo a lenient rate-control strategy ( resting heart rate < 110 beats per minute ) or a strict rate-control strategy ( resting heart rate < 80 beats per minute and heart rate during moderate exercise < 110 beats per minute ) . The primary outcome was a composite of death from cardiovascular causes , hospitalization for heart failure , and stroke , systemic embolism , bleeding , and life-threatening arrhythmic events . The duration of follow-up was at least 2 years , with a maximum of 3 years . RESULTS The estimated cumulative incidence of the primary outcome at 3 years was 12.9 % in the lenient-control group and 14.9 % in the strict-control group , with an absolute difference with respect to the lenient-control group of -2.0 percentage points ( 90 % confidence interval , -7.6 to 3.5 ; P<0.001 for the prespecified noninferiority margin ) . The frequencies of the components of the primary outcome were similar in the two groups . More patients in the lenient-control group met the heart-rate target or targets ( 304 [ 97.7 % ] , vs. 203 [ 67.0 % ] in the strict-control group ; P<0.001 ) with fewer total visits ( 75 [ median , 0 ] , vs. 684 [ median , 2 ] ; P<0.001 ) . The frequencies of symptoms and adverse events were similar in the two groups . CONCLUSIONS In patients with permanent atrial fibrillation , lenient rate control is as effective as strict rate control and is easier to achieve . ( Clinical Trials.gov number , NCT00392613 .
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 .