A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke
Open accessAbstract
AIMS: The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke. METHODS AND RESULTS: The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400. CONCLUSION: Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.
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Similar effects have been reported using single-lead ECG screening in other at-risk populations.
“Opportunistic screening for silent AF seems cost-effective in elderly populations (e.g.> 65 years), 131 and similar effects have been reported using single-lead ECG screening in other at-risk populations.132,133”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [133]
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Research works printed but not linked: 1
- Friberg L, Engdahl J, Frykman V, Svennberg E, Levin LA ˚, Rosenqvist M. Population screening of 75-and 76-year-old men and women for silent atrial fibrillation (STRO- KESTOP). Europace 2013;15:135 -40.
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Apple watch, wearables, and heart rhythm: where do we stand?
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- Authors
- Levin, L.-A., Husberg, M., Sobocinski, P. D., Kull, V. F., Friberg, L., Rosenqvist, M., & Davidson, T.
- Affiliations
- Linköping University (SE)
- Danderyds sjukhus (SE)
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10-27
- Volume
- 17
- Issue
- 2
- Pages
- 207-214
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2122796266
- Cited by
- 56
- References
- 39
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 3 · 2019: 11 · 2018: 4 · 2017: 6 · 2016: 10 · 2015: 2
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Funders
- VINNOVA
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- silent atrial fibrillation, ischemic stroke, screening, Holter monitoring, cost-effectiveness, anticoagulation, stroke prevention, quality-adjusted life years, elderly patients
- MeSH terms
- Aged, Atrial Fibrillation, Brain Ischemia, Cost-Benefit Analysis, Electrocardiography, Humans, Markov Chains, Mass Screening, Sweden, Electrocardiography, Ambulatory, Quality-Adjusted Life Years, Stroke, Secondary Prevention, Asymptomatic Diseases
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