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Atrial fibrillation screening back in the picture

Population screening for atrial fibrillation is once more up for discussion as a new study shows that people with newly diagnosed ‘silent’ AF actually have a higher risk of stroke than those with a symptomatic condition.

The study, presented this week at the European Heart Rhythm Association meeting in Vienna, included over 6,000 consecutively enrolled patients with non-valvular atrial fibrillation, of whom around two-thirds were asymptomatic or minimally symptomatic at time of diagnosis.

The study found those with asymptomatic AF had more than double the risk of previous stroke, compared to those who were symptomatic (14.7% vs 6.0%). They were also more likely to have permanent atrial fibrillation than those in the symptomatic group (15.8% vs 8.3%).

But both symptomatic and asymptomatic patients in this study had a similar number of stroke risk factors, with an average CHA2DS2-VASc score of 3.3 for each group.

Lead author Dr Steffen Christow, a cardiologist at Hospital Ingolstadt in Germany, said the higher rate of stroke despite the same number of stroke risk factors may be explained by a longer undiagnosed history of AF in those with asymptomatic disease.

“Our study found that in Western Europe, two-thirds of patients newly diagnosed with atrial fibrillation were asymptomatic. Without detection, patients may not receive appropriate preventive therapy and remain at increased risk of stroke.”

He said the results “underline the urgent need for public programs to detect atrial fibrillation in the general population”.

In Australia, RACGP guidelines do not recommend systematic screening for atrial fibrillation, although they say opportunistic screening when taking blood pressure could be cost-effective.

The current study is a sub-analysis of the GLORIA-AF registry, which characterises a population of newly diagnosed patients with non-valvular atrial fibrillation at risk for stroke, studying patterns, predictors and outcomes of different treatment regimens for stroke prevention.

You can access the study abstract here.