USPSTF lacks evidence to make recommendation on atrial fibrillation screening
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The U.S. Preventive Services Task Force said there is insufficient evidence to recommend atrial fibrillation screening for adults aged 50 years or older without a diagnosis or symptoms and no history of transient ischemic attack or stroke.
The final recommendation was recently published in JAMA.
Among all arrythmia disorders, atrial fibrillation is the most common, according to the USPSTF. In 2019, atrial fibrillation was noted on 183,321 death certificates issued in the U.S. and was the primary diagnosis of more than 454,000 hospitalizations annually, the CDC said on its website.
“Clinicians should use their clinical judgment regarding whether to screen and how to screen for [atrial fibrillation],” the USPSTF wrote.
The task force said it is “uncertain” whether the prevalence of the condition differs by race and ethnicity. However, according to the CDC, individuals of European descent are more likely than African American individuals to have atrial fibrillation.
The USPSTF noted its final recommendation aligns with its 2021 draft recommendation and 2018 recommendations in this clinical area, and has the support of the American Academy of Family Physicians. The task force said it lowered the inclusion age — which was 65 years in its 2018 recommendation — to 50 years “to be inclusive of all potential evidence on screening for [atrial fibrillation].”
“Lowering the inclusion age was not intended to dilute the evidence in older adults in any way, nor did it,” the task force added.
In a related editorial, Philip Greenland, MD, JAMA editor and professor of preventive medicine and medicine at Northwestern University’s Feinberg School of Medicine, wrote that “many questions about screening for atrial fibrillation remain unanswered.”
He encouraged future trial investigators to consider exclusively enrolling patients at higher risk for atrial fibrillation, as well as trials containing large cohorts and longer continuous monitoring periods. Wearable devices, he added, could allow for long-term monitoring.
“There is great enthusiasm for [atrial fibrillation] screening and optimism for the future role of wearables that could revolutionize this field, provide more precise targeting of anticoagulant drugs and simultaneously reduce overall risks of stroke in atrial fibrillation,” Greenland wrote. “The hope is that a future USPSTF report will eventually be able to either endorse — or advise clearly against — [atrial fibrillation] screening by ECG based on clear, objective evidence from well-conducted randomized trials.”
References:
CDC. Atrial fibrillation. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm. Accessed Jan. 21, 2022.
Greenland P. JAMA. 2022;327(4): 329-330.
Kahwati LC, et al. JAMA. 2022;doi:10.1001/jama.2021.2181.
USPSTF. JAMA. 2022;doi:10.1001/jama.2021.23732.