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Jury still out on value of screening for atrial fibrillation

Reuters Health - 25/01/2022 - There remains insufficient evidence to gauge the benefits and harms of screening for atrial fibrillation in asymptomatic adults aged 50 and older, the U.S. Preventive Services Task Force (USPSTF) has concluded after an updated review.

Atrial fibrillation is the most common type of cardiac arrhythmia and its prevalence increases with age, affecting about 10% of adults aged 85 and older. AF is a major risk factor for ischemic stroke. About one in five people are diagnosed with AF after suffering a stroke.

Based on the latest evidence review, the task force determined there is not enough evidence to recommend for or against screening for AF, and therefore issued an "I" (insufficient evidence) statement.

This recommendation applies to adults 50 years or older without a diagnosis of or symptoms of AF and without a history of transient ischemic attack or stroke.

The updated recommendation matches the 2018 USPSTF recommendation on AF screening with electrocardiography (ECG).

For the evidence review, the task force expanded the scope of the review to include additional screening methods such as automated blood pressure cuffs, pulse oximeters, and consumer devices such as smartwatches and smartphone apps.

"However, even with this expanded scope, the USPSTF did not find enough evidence to recommend for or against screening for AF," the task force said in JAMA.

"Unfortunately, there still is not enough evidence to know if screening for AF helps to prevent strokes in older adults," task force member Dr. Gbenga Ogedegbe said in a news release.

"Since AF is a risk factor for stroke and can go undetected, clinicians should use their best judgment to decide whether or not to screen people without signs or symptoms of AF," Dr. Ogedegbe added.

In an editorial in JAMA, Dr. Philip Greenland of Northwestern University Feinberg School of Medicine in Chicago says "many questions about screening for atrial fibrillation remain unanswered."

"But there is great enthusiasm for AF screening and optimism for the future role of wearables that could revolutionize this field, provide more precise targeting of anticoagulant drugs, and simultaneously reduce overall risks of stroke in atrial fibrillation," Dr. Greenland notes.

"The hope is that a future USPSTF report will eventually be able to either endorse - or advise clearly against - AF screening by ECG based on clear, objective evidence from well-conducted randomized trials," he points out.

SOURCES: https://bit.ly/3H0laap; https://bit.ly/3AxLd6L; https://bit.ly/3FZKcp0 and https://bit.ly/35oQbaj JAMA, online January 25, 2022.

By Reuters Staff

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