Universal screening may be useful to detect AF eligible for catheter ablation
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Data from a Japanese registry suggest universal health screenings can detect atrial fibrillation that improves after medical therapy or catheter ablation, particularly among younger adults who are more likely to be asymptomatic.
The 12‐lead ECG test is included in the Japanese health screening; however, few other countries or medical systems have it as part of their screening programs, Seiji Takatsuki, MD, PhD, FHRS, of the department of cardiology at Keio University School of Medicine in Tokyo, and colleagues wrote in Clinical Cardiology.
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“Clinically, AF with a low CHADS2 score, as seen in the young population, may not correspond to a high risk of thromboembolism,” the researchers wrote. “However, asymptomatic patients remain undetected unless health screening is universally employed. Health screening may reduce the adverse effects of AF.”
Takatsuki and colleagues analyzed data from 3,318 consecutive newly referred AF cases and compared demographic characteristics and health‐related and clinical outcomes among two groups created based on the mode of AF detection (health screening vs. no health screening). Researchers assessed health‐related outcomes via the AF Effect on Quality‐of‐life (AFEQT) questionnaire at baseline and at 1-year follow‐up.
Within the cohort, 25% of patients were diagnosed with AF via health screening. Compared with those diagnosed outside of a health screening, patients diagnosed via a health screening had lower mean CHADS2 scores (1.01 vs. 1.5; P < .001), had a higher prevalence of persistent AF (OR = 2.21; 95% CI, 1.88-2.6), were three times more likely to have an asymptomatic presentation (OR = 3.19; 95% CI, 2.71-3.76) and had better baseline quality of life scores (mean, 83.6 vs. 75; P < .001).
Catheter ablation was more frequently performed in the health screening group at follow‐up (44.4% vs. 34.1%; P < .001). At 1‐year follow‐up, the AFEQT scores of the health screening group improved across most subdomains, according to the researchers.
“Our findings highlight the significance of health screenings in proactive and opportunistic AF detection and demonstrate that a considerable number of patients with permanent AF remain asymptomatic among the younger age group,” the researchers wrote. “Furthermore, relying on data from this cohort, patients’ subjective complaints may have a low diagnostic value in AF detection.”
The researchers noted that the cost‐effectiveness of screening the whole population, including young people, is controversial; however, the improvement in quality of life with medical intervention “is obvious.”
“Therefore, health screening‐detected AF should be followed by medical care,” the researchers wrote.
As Healio previously reported, the U.S. Preventive Services Task Force in 2021 announced there is insufficient evidence to make a recommendation on screening asymptomatic patients aged 50 years and older for AF. The evidence review authors noted that more studies are needed to juxtapose the benefits and harms of screening for AF against usual care and to assess early AF treatment benefits as well as early rate and rhythm control in screen-detected, asymptomatic persons.
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