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 .
The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: approaches to control rate in atrial fibrillation.
OBJECTIVES We sought to evaluate approaches used to control rate , the effectiveness of rate control , and switches from one drug class to another in the Atrial Fibrillation Follow-up Investigation of Rhythm Management ( AFFIRM ) study . BACKGROUND The AFFIRM study showed that atrial fibrillation ( AF ) can be treated effectively with rate control and anticoagulation , but drug efficacy to control rate remains uncertain . METHODS Patients ( n = 2,027 ) r and omized to rate control in the AFFIRM study were given rate-controlling drugs by their treating physicians . St and ardized rate-control efficacy criteria developed a priori included resting heart rate and 6-min walk tests and /or ambulatory electrocardiographic results . RESULTS Average follow-up was 3.5 + /- 1.3 years . Initial treatment included a beta-adrenergic blocker ( beta-blocker ) alone in 24 % , a calcium channel blocker alone in 17 % , digoxin alone in 16 % , a beta-blocker and digoxin in 14 % , or a calcium channel blocker and digoxin in 14 % of patients . Overall rate control was achieved in 70 % of patients given beta-blockers as the first drug ( with or without digoxin ) , 54 % with calcium channel blockers ( with or without digoxin ) , and 58 % with digoxin alone . Adequate overall rate control was achieved in 58 % of patients with the first drug or combination . Multivariate analysis revealed an association between first drug class and several clinical variables . There were more changes to beta-blockers than to the other two-drug classes ( p < 0.0001 ) . CONCLUSIONS Rate control in AF is possible in the majority of patients with AF . Beta-blockers were the most effective drugs . To achieve the goal of adequate rate control in all patients , frequent medication changes and drug combinations were needed
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 .