Screening to identify unknown atrial fibrillation: A systematic review
Abstract
Summary Atrial fibrillation (AF) is associated with a significantly increased stroke risk which is highly preventable with appropriate oral anticoagulant therapy (OAC). However, AF may be asymptomatic and unrecognised prior to stroke. We aimed to determine if single time-point screening for AF could identify sufficient numbers with previously undiagnosed AF, to be effective for stroke prevention. This is a systematic review of clinical trials, by searching electronic medical databases, reference lists and grey literature. Studies were included if they evaluated a general ambulant adult population, using electrocardiography or pulse palpation to identify AF. We identified 30 individual studies (n=122,571, mean age 64 years, 54% male) in nine countries. Participants were recruited either from general practitioner and outpatient clinics (12 studies) or population screening/community advertisements (18 studies). Prevalence of AF across all studies was 2.3% (95% CI, 2.2–2.4%), increasing to 4.4% (CI, 4.1–4.6%) in those ≥65 years (16 studies, n= 27,884). Overall incidence of previously unknown AF (14 studies, n=67,772) was 1.0% (CI, 0.89–1.04%), increasing to 1.4% (CI, 1.2–1.6%) in those ≥65 years (8 studies, n= 18,189) in whom screening setting did not influence incidence identified. Of those with previously unknown AF, 67% were at high risk of stroke. Screening can identify 1.4% of the population ≥65 years with previously undiagnosed AF. Many of those identified would be eligible for, and benefit from OAC to prevent stroke. Given this incidence, community AF screening strategies in at risk older age groups could potentially reduce the overall health burden associated with AF.
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Screening of elderly populations with mean age 64 years yielded a prevalence of 2.3% for chronic forms of AF in 122,571 participants using either short-term ECG or pulse palpation.
“Screening of elderly populations (mean age 64 years) yielded a prevalence of 2.3% for chronic forms of AF in 122,571 participants using either short-term ECG or pulse palpation (followed by ECG in those with an irregular pulse).134”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [134]
Previously undiagnosed AF was found in 1.4% of those aged >65 years, suggesting a number needed to screen of 70.
“Previously undiagnosed AF was found in 1.4% of those aged > 65 years, suggesting a number needed to screen of 70.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [134]
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- Authors
- Lowres, N., Neubeck, L., Redfern, J., & Freedman, S. B.
- Affiliations
- Concord Repatriation General Hospital (AU)
- The George Institute for Global Health (AU)
- Venue
- Thrombosis and Haemostasis
- Publisher
- Georg Thieme Verlag KG
- Published
- 2013
- Volume
- 110
- Issue
- 08
- Pages
- 213-222
- ISSN
- 0340-6245 (ISSN-L)
- 2567-689X
- OpenAlex
- W1614663039
- Cited by
- 327
- References
- 63
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 15 · 2023: 15 · 2022: 27 · 2021: 24 · 2020: 34 · 2019: 30 · 2018: 39 · 2017: 36 · 2016: 28 · 2015: 26 · 2014: 28 · 2013: 2
- FWCI
- 4.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thrombosis and Haemostasis (publishedVersion)
- Funders
- National Heart Foundation Postgraduate Scholarship (PP12S6990)
- NHMRC early career fellowship (1036763)
- Postdoctoral Fellowship
- NHMRC and National Heart Foundation (632933)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- atrial fibrillation, asymptomatic atrial fibrillation, stroke prevention, oral anticoagulation, electrocardiography screening, pulse palpation, community-based screening, older adults, atrial fibrillation prevalence, atrial fibrillation incidence, stroke risk
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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