Community-Based Screening Identifies Patients ≥ 75 years old with Atrial Fibrillation Suitable for Anticoagulants for Stroke Prevention
EBM Focus - Volume 8, Issue 6
Treatment with oral anticoagulants is recommended for patients with atrial fibrillation and high stroke risk (Chest 2012 Feb;141(2 Suppl):e531S). The standard tool for stroke risk assessment is the CHADS2 score, which assigns a single point for each of Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes and 2 points for history of Stroke. A score of ≥ 2 is considered high risk. A recent population-based cohort study conducted in Sweden assessed the efficacy of a stepwise screening program to identify patients with high stroke risk who would be suitable for anticoagulant treatment.
Invitations to participate in the screening program were sent to all residents of Halmsted, Sweden aged 75-76 years (1,330 residents). The first step in screening included relevant medical history and a 12-lead electrocardiogram (ECG). Participants in sinus rhythm with no history of atrial fibrillation who had a CHADS2 score ≥ 2 (age plus at least 1 other factor) were invited to perform self ECG recording with a hand-held device for 2 weeks (20-30 seconds twice daily and if palpitations).
Of 848 residents that accepted the screening invitation, 9% (75 participants) were identified as candidates for starting oral anticoagulant treatment. This included 35 patients with a known history of atrial fibrillation who were not already receiving treatment, 10 who were diagnosed with silent atrial fibrillation on the 12-lead ECG, and 30 who were diagnosed with paroxysmal atrial fibrillation. Of these patients, 57 (76%) began anticoagulant treatment. No treatment outcomes were reported (level 3 [lacking direct] evidence) (Circulation 2013 Jan 23 early online) Looking for a reduction in stroke incidence was beyond the scope of this study and demonstrating that screening can lead to lower stroke rates requires additional research. However, this study does indicate that there may be significant numbers of patients eligible for stroke prophylaxis who are not currently being treated and who can be identified through an outreach program.
For more information, see the Atrial fibrillation topic in DynaMed.