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 .
Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community: Characteristics and prognostic implications.
BACKGROUND The prognostic significance of the clinical presentation of atrial fibrillation ( AF ) is poorly defined . OBJECTIVE The purpose of this study was to determine the frequency , associations , and prognostic impact of different clinical presentations of new-onset AF . METHODS One thous and patients with incident AF in Olmsted County , Minnesota , were r and omly selected ( 2000 - 2010 ) . Patients with AF that was complicated at presentation ( heart failure [ n = 71 ] , thromboembolism [ n = 24 ] ) , provoked ( n = 346 ) , or unable to determine symptoms ( n = 83 ) were excluded . In the remaining patients , characteristics and prognosis associated with different types of symptoms were examined . RESULTS Among 476 patients , 193 had typical ( palpitations ) , 122 had atypical ( other non-palpitation symptoms ) , and 161 had asymptomatic AF presentation . Patients with typical presentation had lower CHA2DS2-VASc scores ( mean 2.3 ± 2 ) compared to atypical and asymptomatic presentation ( mean 3.2 ± 1.8 and 3.3 ± 1.9 , respectively ; P < .001 ) . Fifty-nine cerebrovascular events and 149 deaths ( n = 49 cardiovascular ) were documented over median 5.6 and 6.0 years , respectively . Atypical and asymptomatic AF conferred higher risks of cerebrovascular events compared to typical AF after adjustment for CHA2DS2-VASc score and age ( hazard ratio [ HR ] 3.51 , 95 % confidence interval [ CI ] 1.65 - 7.48 , and HR 2.70 , 95 % CI 1.29 - 5.66 , respectively ) , and associations remained statistically significant after further adjustments including comorbidities and warfarin use . Asymptomatic AF was associated with an increased risk of cardiovascular ( HR 3.12 , 95 % CI 1.50 - 6.45 ) and all-cause mortality ( HR 2.96 , 95 % CI 1.89 - 4.64 ) compared to typical AF after adjustment for CHA2DS2-VASc score and age . CONCLUSION The type of clinical presentation may have important implication s for the prognosis of new-onset AF in the community
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 .