Opportunistic screening doesn’t find more AF cases

Reuters Health - 25/09/2020 - Opportunistic screening of primary-care patients 65 and older for atrial fibrillation (AF) does not increase detection, according to new findings.

"Future research on screening for atrial fibrillation should focus on the selection of patients with the highest risk of having or developing undetected atrial fibrillation and the role of repeated or prolonged monitoring," Dr. Steven B. Uittenbogaart of the University of Amsterdam in The Netherlands and colleagues conclude in The BMJ.

The Screening for Atrial Fibrillation in the Elderly (SAFE) trial, published in 2007, found that opportunistic screening by pulse palpation detected more AF cases than usual care, the authors note. However, the findings haven't been replicated in randomized trials, they add, and it's unclear whether increased detection affects clinical endpoints including stroke and death.

In the new Detecting and Diagnosing Atrial Fibrillation (D2AF) study, Dr. Uittenbogaart and colleagues randomized primary-care practices to intent-to-screen (47) or usual care (49), randomly sampling 200 patients from each practice.

Screening consisted of pulse palpation, electronic blood pressure measurement with an AF algorithm, and electrocardiography (ECG) with a hand-held single-lead device. Patients with at least one positive test underwent 12-lead ECG. If the test did not find AF, they were invited to undergo Holter monitoring.

The intention-to-screen group included more than 9,000 patients, 4,106 of whom were screened, and slightly more patients who received usual care. There were 144 new AF cases diagnosed in the intent-to-screen group (1.62%), versus139 (1.53%) in the usual care group, a non-significant difference.

Among the patients who were screened, 488 had at least one positive index test, and 448 underwent 12-lead ECG, which diagnosed 26 patients with AF. Among patients with negative ECGs, 266 underwent Holter monitoring for two weeks, which identified four additional AF cases.

"Our findings showed that one time point screening missed silent and paroxysmal atrial fibrillation," Dr. Uittenbogaart and colleagues note.

"The uptake of continuous rhythm monitoring as a means of screening for atrial fibrillation might be more effective with new and wireless technologies, such as smart watches or wireless patches," they add.

Dr. Uittenbogaart was not available for an interview by press time.

By Reuters Staff

SOURCE: https://bit.ly/2RWrYOo BMJ, online September 16, 2020.



Posted on 25 September, 202030 September, 2020