Among older individuals, screening for atrial fibrillation (AF) is safe and shows a benefit compared with standard clinical care, according to a study published in The Lancet.
For the STROKESTOP randomized controlled trial (ClinicalTrials.gov Identifier: NCT01593553), researchers enrolled 28,768 individuals aged 75 to 76 years and randomly assigned them 1:1 to screening or control groups. All screenings took place between March 2012 and May 2014 in 2 Swedish cities.
Participants with no history of AF were asked to receive intermittent electrocardiograms (ECGs) at local screening centers for 2 weeks. If AF was detected or untreated, participants were offered treatment with oral anticoagulants. Follow-up lasted for a minimum of 5 years with a median follow-up of 6.9 years (IQR, 6.5-7.2). Primary endpoints included systemic embolism, hemorrhagic or ischemic stroke, all-cause mortality, and bleeding requiring hospitalization.
Compared with participants, nonparticipants in the intervention group had significantly more medications, comorbidities, and sociodemographic difficulties; they also experienced higher rates of AF at baseline (14.1% vs 10.2%; P <.0001). The intervention group had a significantly lower rate of primary endpoints (31.9%; n=4456 out of 13,979; 5.45 [5.29-5.61] events per 100 years) compared with the control group (33.0%; n=4616 out of 13,996; 5.68 [5.52-5.85] events per 100 years), with a hazard ratio of 0.96 (95% CI, 0.92-1.00; P =.045).
Limitations to this study include an overestimation of modern incidence of stroke, the use of major bleeding as an indicator of harm, low sensitivity of clinical diagnoses of dementia, potential attrition bias, and potential for ECG screening for AF to lead to harm.
“Screening for atrial fibrillation in an older population showed a significant benefit by reducing hard clinical outcomes,” the study authors said. “Screening for atrial fibrillation is likely to show a greater difference in outcomes in populations with lower spontaneous detection of atrial fibrillation, as well as in settings with higher participation rates.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Svennberg E, Friberg L, Frykman V, Al-Khalili F, Engdahl J, Rosenqvist M. Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial. Lancet. Published online August 29, 2021. doi:10.1016/S0140-6736(21)01637-8