Screening for atrial fibrillation with electrocardiography

US preventive services task force recommendation statement

Susan J. Curry, Alex H. Krist, Douglas K. Owens, Michael J. Barry, Aaron Caughey, Karina W. Davidson, Chyke A. Doubeni, John W. Epling, Alex R. Kemper, Martha Kubik, C. Seth Landefeld, Carol M. Mangione, Michael Silverstein, Melissa A. Simon, Chien Wen Tseng, John B. Wong

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

IMPORTANCE Atrial fibrillation is the most common type of cardiac arrhythmia (irregular heartbeat), and its prevalence increases with age, affecting about 3% of men and 2% of women aged 65 to 69 years and about 10% of adults 85 years and older. Atrial fibrillation is a major risk factor for ischemic stroke, increasing risk of stroke by as much as 5-fold. Approximately 20% of patients who have a stroke associated with atrial fibrillation are first diagnosed with atrial fibrillation at the time of stroke or shortly thereafter. OBJECTIVE To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation with electrocardiography (ECG). EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older, the effectiveness of screening with ECG for detecting previously undiagnosed atrial fibrillation compared with usual care, and the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected atrial fibrillation in older adults. FINDINGS Most older adults with previously undiagnosed atrial fibrillation have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment. Anticoagulant therapy is effective for stroke prevention in symptomatic persons with atrial fibrillation and high stroke risk. However, the USPSTF found inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established and include misdiagnosis and invasive testing. Given these uncertainties, it is not possible to determine the net benefit of screening with ECG. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement)

Original languageEnglish (US)
Pages (from-to)478-484
Number of pages7
JournalJAMA - Journal of the American Medical Association
Volume320
Issue number5
DOIs
StatePublished - Aug 7 2018

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Advisory Committees
Atrial Fibrillation
Electrocardiography
Stroke
Anticoagulants
Therapeutics
Diagnostic Errors
Uncertainty
Cardiac Arrhythmias

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Screening for atrial fibrillation with electrocardiography : US preventive services task force recommendation statement. / Curry, Susan J.; Krist, Alex H.; Owens, Douglas K.; Barry, Michael J.; Caughey, Aaron; Davidson, Karina W.; Doubeni, Chyke A.; Epling, John W.; Kemper, Alex R.; Kubik, Martha; Seth Landefeld, C.; Mangione, Carol M.; Silverstein, Michael; Simon, Melissa A.; Tseng, Chien Wen; Wong, John B.

In: JAMA - Journal of the American Medical Association, Vol. 320, No. 5, 07.08.2018, p. 478-484.

Research output: Contribution to journalReview article

Curry, SJ, Krist, AH, Owens, DK, Barry, MJ, Caughey, A, Davidson, KW, Doubeni, CA, Epling, JW, Kemper, AR, Kubik, M, Seth Landefeld, C, Mangione, CM, Silverstein, M, Simon, MA, Tseng, CW & Wong, JB 2018, 'Screening for atrial fibrillation with electrocardiography: US preventive services task force recommendation statement', JAMA - Journal of the American Medical Association, vol. 320, no. 5, pp. 478-484. https://doi.org/10.1001/jama.2018.10321
Curry, Susan J. ; Krist, Alex H. ; Owens, Douglas K. ; Barry, Michael J. ; Caughey, Aaron ; Davidson, Karina W. ; Doubeni, Chyke A. ; Epling, John W. ; Kemper, Alex R. ; Kubik, Martha ; Seth Landefeld, C. ; Mangione, Carol M. ; Silverstein, Michael ; Simon, Melissa A. ; Tseng, Chien Wen ; Wong, John B. / Screening for atrial fibrillation with electrocardiography : US preventive services task force recommendation statement. In: JAMA - Journal of the American Medical Association. 2018 ; Vol. 320, No. 5. pp. 478-484.
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abstract = "IMPORTANCE Atrial fibrillation is the most common type of cardiac arrhythmia (irregular heartbeat), and its prevalence increases with age, affecting about 3{\%} of men and 2{\%} of women aged 65 to 69 years and about 10{\%} of adults 85 years and older. Atrial fibrillation is a major risk factor for ischemic stroke, increasing risk of stroke by as much as 5-fold. Approximately 20{\%} of patients who have a stroke associated with atrial fibrillation are first diagnosed with atrial fibrillation at the time of stroke or shortly thereafter. OBJECTIVE To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation with electrocardiography (ECG). EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older, the effectiveness of screening with ECG for detecting previously undiagnosed atrial fibrillation compared with usual care, and the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected atrial fibrillation in older adults. FINDINGS Most older adults with previously undiagnosed atrial fibrillation have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment. Anticoagulant therapy is effective for stroke prevention in symptomatic persons with atrial fibrillation and high stroke risk. However, the USPSTF found inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established and include misdiagnosis and invasive testing. Given these uncertainties, it is not possible to determine the net benefit of screening with ECG. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement)",
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T2 - US preventive services task force recommendation statement

AU - Curry, Susan J.

AU - Krist, Alex H.

AU - Owens, Douglas K.

AU - Barry, Michael J.

AU - Caughey, Aaron

AU - Davidson, Karina W.

AU - Doubeni, Chyke A.

AU - Epling, John W.

AU - Kemper, Alex R.

AU - Kubik, Martha

AU - Seth Landefeld, C.

AU - Mangione, Carol M.

AU - Silverstein, Michael

AU - Simon, Melissa A.

AU - Tseng, Chien Wen

AU - Wong, John B.

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N2 - IMPORTANCE Atrial fibrillation is the most common type of cardiac arrhythmia (irregular heartbeat), and its prevalence increases with age, affecting about 3% of men and 2% of women aged 65 to 69 years and about 10% of adults 85 years and older. Atrial fibrillation is a major risk factor for ischemic stroke, increasing risk of stroke by as much as 5-fold. Approximately 20% of patients who have a stroke associated with atrial fibrillation are first diagnosed with atrial fibrillation at the time of stroke or shortly thereafter. OBJECTIVE To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation with electrocardiography (ECG). EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older, the effectiveness of screening with ECG for detecting previously undiagnosed atrial fibrillation compared with usual care, and the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected atrial fibrillation in older adults. FINDINGS Most older adults with previously undiagnosed atrial fibrillation have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment. Anticoagulant therapy is effective for stroke prevention in symptomatic persons with atrial fibrillation and high stroke risk. However, the USPSTF found inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established and include misdiagnosis and invasive testing. Given these uncertainties, it is not possible to determine the net benefit of screening with ECG. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement)

AB - IMPORTANCE Atrial fibrillation is the most common type of cardiac arrhythmia (irregular heartbeat), and its prevalence increases with age, affecting about 3% of men and 2% of women aged 65 to 69 years and about 10% of adults 85 years and older. Atrial fibrillation is a major risk factor for ischemic stroke, increasing risk of stroke by as much as 5-fold. Approximately 20% of patients who have a stroke associated with atrial fibrillation are first diagnosed with atrial fibrillation at the time of stroke or shortly thereafter. OBJECTIVE To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation with electrocardiography (ECG). EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older, the effectiveness of screening with ECG for detecting previously undiagnosed atrial fibrillation compared with usual care, and the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected atrial fibrillation in older adults. FINDINGS Most older adults with previously undiagnosed atrial fibrillation have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment. Anticoagulant therapy is effective for stroke prevention in symptomatic persons with atrial fibrillation and high stroke risk. However, the USPSTF found inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established and include misdiagnosis and invasive testing. Given these uncertainties, it is not possible to determine the net benefit of screening with ECG. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement)

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DO - 10.1001/jama.2018.10321

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