USPSTF Draft Recommendation
Evidence on Screening for Atrial Fibrillation Inconclusive
May 4, 2021, 11:35 a.m. News Staff — On April 20, the U.S. Preventive Services Task Force published a draft recommendation statement and draft evidence review on screening for atrial fibrillation.
Based on the available evidence, the task force concluded that the current evidence is insufficient to assess the balance and harms of screening for AFib. This is an “I” recommendation, and applies to adults 50 and older who do not have a diagnosis of or symptoms of the condition.
“Atrial fibrillation is a major risk factor for stroke, and it often goes undetected,” said task force member Gbenga Ogedegbe, M.D., M.P.H., in a press release. “Unfortunately, there is not enough evidence to determine whether or not screening for atrial fibrillation helps prevent stroke, so physicians and health care providers should use their clinical judgment when deciding whether to screen their patients.”
Atrial fibrillation is the most common type of heart arrythmia, resulting in more than 450,000 hospitalizations and contributing to nearly 160,000 deaths in the United States each year. The prevalence of the condition increases with age, from less than 0.2% in adults younger than 55 to about 10% in those 85 and older. Additional risk factors for AFib include high blood pressure, obesity, diabetes and smoking.
Update of Existing Recommendation
When finalized, the draft recommendation will replace the task force’s existing recommendation statement on the topic, which was published in 2018. The AAFP supported the 2018 statement.
Story Highlights
In the 2018 statement, the task force also concluded that the evidence was insufficient to assess the balance of benefits and harms of screening for AFib using electrocardiography. For the current draft recommendation, the task force expanded its review to include other screening tests in addition to electrocardiography.
To update the existing recommendation, the task forced commissioned a systematic evidence review of eligible studies and trial registries published through Oct. 5, 2020, with additional surveillance of the literature conducted through Jan. 31, 2021. A total of 24 studies were included in the review.
The review found that while screening with various ECG methods in primary care settings can detect more cases of previously unknown atrial fibrillation compared with no screening, there was little direct evidence available to evaluate the benefits and harms of screening.
The review also found that spot one-time ECG screenings may not detect more new cases of AFib than provider reminders for pulse palpation (a practice considered usual care by the USPSTF), and that in low-prevalence settings, spot one-time screening tests will generate more false-positive than true-positive results.
The task force found no trials that reported on the benefits or harms of anticoagulant therapy in screen-detected populations. In patients with clinically detected AFib, however, a meta-analysis found that anticoagulant therapies such as warfarin or direct oral anticoagulants reduced the risk of outcomes such as stroke, systemic embolism and all-cause mortality compared with placebo.
The task force also noted some research gaps that could be addressed through additional studies, including:
- conducting randomized trials of asymptomatic people without known AFib that compare screening with no screening, and assess both health outcomes and harms;
- more research on ways to optimize the accuracy of screening tests and strategies; and
- additional research on the benefits of early treatment, in particular, the use of anticoagulation therapies in individuals with subclinical AFib.
Other Recommendations and Resources
The task force noted that it has published recommendation statements on several other factors related to the prevention of cardiovascular disease and stroke, including screening for hypertension, statin use for the primary prevention of cardiovascular disease, interventions for tobacco smoking cessation, and behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with and without known risk factors.
The task force also provided links to two resources for clinicians: The CDC’s atrial fibrillation patient education webpage and the Million Hearts initiative.
Next Steps
The USPSTF will accept comments on the draft recommendation statement and draft evidence review until 11:59 p.m. EDT on May 17.
All comments will be considered as the task force prepares its final recommendation.