Screening older patients for AFib during regular care is feasible, but not productive
Screening older patients for atrial fibrillation (AFib) during primary care visits provides little value, according to new research published in Circulation.[1]
The study’s authors noted that AFib can often be asymptomatic. This study asked the question if regular screening with electrocardiograms (ECGs) could help high-risk patients receive the care they need?
“We aimed to assess whether routine screening of older adults using single-lead ECGs is more effective for diagnosing AF than usual care in a contemporary primary care practice setting,” wrote lead author Steven A. Lubitz, MD, a cardiologist and cardiac electrophysiologist with Massachusetts General Hospital in Boston, and colleagues. “We hypothesized that such screening would identify more patients with AFib, to enable efficient initiation of oral anticoagulation for those with confirmed AFib at elevated stroke risk.”
Lubitz et al. examined data from more than 15,000 older patients who were screened for AFib with a single-lead ECG. A control group of more than 15,000 older patients also was included in the group’s analysis and underwent normal care.
Patients were seen from July 31, 2018, to Oct. 8, 2019, at one of 16 primary care clinics. The participating clinics were all part of the same U.S. health system. All patients were all 65 years old or older.
Overall, at one year, newly diagnosed AFib was seen in 1.72% of patients in the screening group and 1.59% in the usual care group.
“Screening all individuals aged ≥ 65 years at primary care clinic visits for AFib with a single lead handheld electrocardiogram is not an efficient way to identify undiagnosed AFib,” the authors wrote.
However, among patients 85 years and older, the rates of newly diagnosed AFib were 5.56% for the screening group and 3.76% for the usual care group. This suggests, the team noted, that screening this specific patient population could make an impact on patient care.
“Considering that advanced age is associated with a substantially increased risk of both AFib 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 group wrote.
Funding for this study was provided by the Bristol Myers Squibb-Pfizer Alliance, but those vendors had no role in the study design, data collection, data analysis, data interpretation or writing of the report. Multiple study authors, including Lubitz, reported a prior relationship with Bristol. Myers Squibb and Pfizer.
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.