Stepwise Screening of Atrial Fibrillation in a 75-Year-Old Population: Implications for Stroke Prevention
Abstract
Background—: Atrial fibrillation (AF) is a frequent source of cardiac emboli in patients with ischemic stroke. AF may be asymptomatic and therefore undiagnosed. Screening for silent AF seems suitable in risk populations, however little is known on the yield and cost-effectiveness of such screening. Methods and Results—: All inhabitants in the municipality of Halmstad, Sweden aged 75 to 76 years were invited to a stepwise screening program for AF. As a first step, participants recorded a 12-lead ECG and reported their relevant medical history. Those with sinus rhythm on 12-lead ECG, no history of AF, and ≥2 risk factors according to CHADS 2 were invited to a 2-week recording period using a hand-held ECG and asked to record 20 or 30 seconds twice daily and if palpitations occurred. One thousand, three hundred thirty inhabitants were invited, of whom 848 (64%) participated. Previously undiagnosed silent AF was found in 10 (1%) among 848 individuals who recorded 12-lead ECG. Among 81 patients with known AF, 35 (43%) were not on oral anticoagulation treatment. Among 403 persons with ≥2 risk factors for stroke, who completed the hand-held ECG event recording, 30 (7.4%) were diagnosed with paroxysmal AF. Thus 75/848 (9%) of the screened population were candidates for new oral anticoagulation treatment, of those 57 actually started oral anticoagulation treatment. Conclusions—: Stepwise risk factor–stratified AF screening in a 75-year-old population yields a large share of candidates for oral anticoagulation treatment on AF indication.
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Repeated daily ECG recordings increased the detection of silent, asymptomatic paroxysmal AF in an unselected Swedish population aged >75 years.
“Repeated daily ECG recordings increased the detection of silent, asymptomatic paroxysmal AF in an unselected Swedish population aged > 75 years.120,135”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [135]
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- Authors
- Engdahl, J., Andersson, L., Mirskaya, M., & Rosenqvist, M.
- Affiliations
- Danderyds sjukhus (SE)
- Venue
- Circulation
- Published
- 2013-02-26
- Volume
- 127
- Issue
- 8
- Pages
- 930-937
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2055181085
- Cited by
- 233
- References
- 10
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 5 · 2023: 10 · 2022: 14 · 2021: 32 · 2020: 16 · 2019: 18 · 2018: 22 · 2017: 15 · 2016: 21 · 2015: 23 · 2014: 23 · 2013: 21
- FWCI
- 19.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial fibrillation, silent atrial fibrillation, CHADS2 score, oral anticoagulation, stroke prevention, event recording, 12-lead ECG, asymptomatic atrial fibrillation, older adults, cost-effectiveness
- MeSH terms
- Age Factors, Aged, Atrial Fibrillation, Female, Humans, Male, Mass Screening, Population Surveillance, Risk Factors, Sweden, Stroke
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