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AF screening in older adults at primary care visits

Presented by
Dr Steven Lubitz, Massachusetts General Hospital, USA
AHA 2020
In the cluster randomised VITAL-AF trial, screening patients during primary care visits using a single-lead ECG was feasible but not associated with a significant increase in new atrial fibrillation (AF) diagnoses compared with usual care [1]. However, it may be useful in patients aged 85 years.

Dr Steven Lubitz (Massachusetts General Hospital, USA) said screening in primary care might be optimal because it can identify people who might benefit from treatment at a large scale and enable efficient treatment initiation. In VITAL-AF (NCT03515057), patients aged ≥65 years from 16 hospital- and community-based practices were randomised 1:1 to usual care or AF screening, using an AliveCor single-lead ECG, during routine visits. The primary endpoint was the rate of newly diagnosed AF over a period of 12 months. A total of 30,722 patients were included.

In the intervention arm, 91% of participants (n=15,397) were screened compared with only 2% of participants in the control group (n=15,325). However, the rate of newly diagnosed AF was not significantly different: 1.74% versus 1.60%, respectively (P=0.33). In patients aged ≥85 years, screening yielded more new diagnosed patients, with an absolute risk difference of 1.88% (number-needed-to-screen: 53).

“Screening all individuals aged 65 or older is not a highly effective way to detect undiagnosed AF, in a practice that resembles ours,” Dr Lubitz concluded. “However, screening older individuals who are at high risk of AF, especially those 85 years and older, may be effective.”

      1. Lubitz S, et al. Screening for Atrial Fibrillation in Older Adults at Primary Care Visits Using Single Lead Electrocardiograms: The VITAL-AF Trial. LBS.06, AHA Scientific Sessions 2020, 13–17 Nov.


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