Universal Screening for Afib in Primary Care: Feasible but not Productive

Universal Screening for Afib in Primary Care: Feasible but not Productive Posted By:
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Recent data from the VITAL-AF study has provided insight into the efficacy of universal point-of-care screenings with single-lead ECG in primary care settings for diagnosis of atrial fibrillation (AF) in older adults. The study authors hypothesized that such screening would identify more patients with AF, and thus enable efficient initiation of oral anticoagulation. Over a screening period of 1 year, 30,715 patients ≥65 years of age from 16 primary care practices were randomly assigned (1:1) to AF screening with a single-lead ECG or usual care.

The results of the VITAL-AF trial demonstrated that screening for AF with single-lead ECG in all individuals aged ≥65 years did not significantly increase the amount of newly diagnosed cases at 12 months. However, subgroup analyses suggest that the ECG screenings could prove useful in patients aged ≥85 years.

At year one, a new diagnosis of AF was made in only 1.72% of the ECG screening group and in 1.59% of the control group—leading the authors to conclude that single-lead ECG screening for AF was not an efficient method to identify undiagnosed AF. In contrast, in the ≥85 year old population, the rate of newly diagnosed AF was 5.56% in the ECG screening group vs 3.76% in the control group. Researchers noted that single-lead ECG screening in this specific patient population might make an impact on patient care.

"Considering that advanced age is associated with a substantially increased risk of both [AF] and stroke, point-of-care screening might be best targeted at the oldest adults, but future prospective validation of this hypothesis-generating observation is warranted," the authors wrote. This research also has implications for other health screenings (ie, school/sports physicals), especially given the controversy on whether ECG screenings would be of benefit in these populations.

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Filed under: Preventive Medicine , Cardiometabolic

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