Screening for Atrial Fibrillation: A Report of the AF-SCREEN International Collaboration

Ben Freedman; John Camm; Hugh Calkins; Jeffrey S Healey; Mårten Rosenqvist; Jiguang Wang; Christine M Albert; Craig S Anderson; Sotiris Antoniou; Emelia J Benjamin; Giuseppe Boriani; Johannes Brachmann; Axel Brandes; Tze-Fan Chao; David Conen; Johan Engdahl; Laurent Fauchier; David A Fitzmaurice; Leif Friberg; Bernard J Gersh; David J Gladstone; Taya V Glotzer; Kylie Gwynne; Graeme J Hankey; Joseph Harbison; Graham S Hillis; Mellanie T Hills; Hooman Kamel; Paulus Kirchhof; Peter R Kowey; Derk Krieger; Vivian W Y Lee; Lars-Åke Levin; Gregory Y H Lip; Trudie Lobban; Nicole Lowres; Georges H Mairesse; Carlos Martinez; Lis Neubeck; Jessica Orchard; Jonathan P Piccini; Katrina Poppe; Tatjana S Potpara; Helmut Puererfellner; Michiel Rienstra; Roopinder K Sandhu; Renate B Schnabel; Chung-Wah Siu; Steven Steinhubl; Jesper H Svendsen; Emma Svennberg; Sakis Themistoclakis; Robert G Tieleman; Mintu P Turakhia; Arnljot Tveit; Steven B Uittenbogaart; Isabelle C Van Gelder; Atul Verma; Rolf Wachter; Bryan P Yan; AF-Screen Collaborators

doi:10.1161/CIRCULATIONAHA.116.026693

Screening for Atrial Fibrillation: A Report of the AF-SCREEN International Collaboration

Circulation. 2017 May 9;135(19):1851-1867. doi: 10.1161/CIRCULATIONAHA.116.026693.

Authors

Ben Freedman¹, John Camm², Hugh Calkins², Jeffrey S Healey², Mårten Rosenqvist², Jiguang Wang², Christine M Albert², Craig S Anderson², Sotiris Antoniou², Emelia J Benjamin², Giuseppe Boriani², Johannes Brachmann², Axel Brandes², Tze-Fan Chao², David Conen², Johan Engdahl², Laurent Fauchier², David A Fitzmaurice², Leif Friberg², Bernard J Gersh², David J Gladstone², Taya V Glotzer², Kylie Gwynne², Graeme J Hankey², Joseph Harbison², Graham S Hillis², Mellanie T Hills², Hooman Kamel², Paulus Kirchhof², Peter R Kowey², Derk Krieger², Vivian W Y Lee², Lars-Åke Levin², Gregory Y H Lip², Trudie Lobban², Nicole Lowres², Georges H Mairesse², Carlos Martinez², Lis Neubeck², Jessica Orchard², Jonathan P Piccini², Katrina Poppe², Tatjana S Potpara², Helmut Puererfellner², Michiel Rienstra², Roopinder K Sandhu², Renate B Schnabel², Chung-Wah Siu², Steven Steinhubl², Jesper H Svendsen², Emma Svennberg², Sakis Themistoclakis², Robert G Tieleman², Mintu P Turakhia², Arnljot Tveit², Steven B Uittenbogaart², Isabelle C Van Gelder², Atul Verma², Rolf Wachter², Bryan P Yan²; AF-Screen Collaborators

Collaborators

AF-Screen Collaborators:
A Al Awwad, F Al-Kalili, T Berge, G Breithardt, G Bury, W Caorsi, N Chan, S Chen, I Christophersen, S Connolly, H Crijns, S Davis, U Dixen, R Doughty, X Du, M Ezekowitz, M Fay, V Frykman, M Geanta, H Gray, N Grubb, A Guerra, J Halcox, R Hatala, H Heidbuchel, R Jackson, L Johnson, S Kaab, K Keane, Y Kim, G Kollios, M Løchen, C Ma, J Mant, M Martinek, I Marzona, K Matsumoto, D McManus, P Moran, N Naik, T Ngarmukos, D Prabhakaran, D Reidpath, A Ribeiro, A Rudd, I Savalieva, R Schilling, M Sinner, S Stewart, N Suwanwela, N Takahashi, E Topol, S Ushiyama, N Verbiest van Gurp, N Walker, T Wijeratne

Affiliations

¹ From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham and Womens Hospital, Harvard Medical School, Boston, MA (C.M.A.); The George Institute for Global Health, Sydney, Australia (C.S.A.); Barts Health NHS Trust, London, UK (S.A.); National Heart, Lung, and Blood Institute and Boston University's Framingham Heart Study, MA (E.J.B.); University of Modena and Reggio Emilia, Italy (G.B.); Klinikum Coburg, Germany (J.B.); Odense University Hospital, Denmark (A.B.); Cardiovascular Research Centre, National Yang-Ming University, Taipei, Taiwan (T.- F.C.); University Hospital, Basel, Switzerland (D.C.); Université François Rabelais, Tours, France (L.F.); University of Birmingham, UK (D.A.F.); Mayo Clinic College of Medicine, Rochester, MN (B.J.G.); University of Toronto, Ontario, Canada (D.J.G., A.V.); Hackensack University Medical Centre, NJ (T.V.G.); Poche Centre, University of Sydney, Australia (K.G.); University of Western Australia, Perth (G.J.H.); Trinity College, Dublin, Ireland (J.H.); Royal Perth Hospital, University of Western Australia (G.S.H.); StopAfib.org, Dallas, TX (M.T.H.); Weill Cornell Medical College, New York (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, UK (P.K.); SWBH and UHB NHS trusts, Birmingham, UK (P.K.); AFNET, Muenster, Germany (P.K.); Lankenau Institute for Medical Research, Wynnewood, OK (P.R.K.); University Hospital of Zurich, Switzerland (D.K.); Chinese University of Hong Kong (V.W.Y.L., B.P.Y.); University of Linköping, Sweden (L.-A.L.); University of Birmingham, UK; Aalborg University, Denmark (G.Y.H.L.); Arrhythmia Alliance, London, UK (T.L.); Charles Perkins Centre, University of Sydney, Australia (N.L.); Cliniques du Sud Luxembourg, Arlon, Belgium (G.H.M.); Institute for Epidemiology Statistics and Informatics, Frankfurt, Germany (C.M.); Edinburgh Napier University, UK (L.N.); Charles Perkins Centre, University of Sydney, Australia (J.O.); Duke University, Durham, NC (J.P.P.); University of Auckland, New Zealand (K.P.); University of Belgrade, Serbia (T.S.P.); KH der Elisabethinen, Ordensklinikum Linz, Austria (H.P.); University of Groningen, University Medical Centre Groningen, The Netherlands (M.R.); University of Alberta, Edmonton, Canada (R.K.S.); University Heart Centre, Hamburg, Germany (R.B.S.); The University of Hong Kong (C.-W.S.); Scripps Translational Science Institute, San Diego, CA (S.S.); Rigshospitalet, The Heart Centre, University of Copenhagen, Denmark (J.H.S.); Ospedale dell'Angelo Venice-Mestre, Venice, Italy (S.T.); Martini Hospital, Groningen, The Netherlands (R.G.T.); Stanford University, CA (M.P.T.); VA Palo Alto Health Care System, CA (M.P.T.); The Department of Medical Research, Bærum Hospital, Rud, Norway (A.T.); Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands (S.B.U.); University of Groningen, University Medical Centre Groningen, The Netherlands (I.C.V.G.); and University of Göttingen, Germany (R.W.). ben.freedman@sydney.edu.au.
² From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham and Womens Hospital, Harvard Medical School, Boston, MA (C.M.A.); The George Institute for Global Health, Sydney, Australia (C.S.A.); Barts Health NHS Trust, London, UK (S.A.); National Heart, Lung, and Blood Institute and Boston University's Framingham Heart Study, MA (E.J.B.); University of Modena and Reggio Emilia, Italy (G.B.); Klinikum Coburg, Germany (J.B.); Odense University Hospital, Denmark (A.B.); Cardiovascular Research Centre, National Yang-Ming University, Taipei, Taiwan (T.- F.C.); University Hospital, Basel, Switzerland (D.C.); Université François Rabelais, Tours, France (L.F.); University of Birmingham, UK (D.A.F.); Mayo Clinic College of Medicine, Rochester, MN (B.J.G.); University of Toronto, Ontario, Canada (D.J.G., A.V.); Hackensack University Medical Centre, NJ (T.V.G.); Poche Centre, University of Sydney, Australia (K.G.); University of Western Australia, Perth (G.J.H.); Trinity College, Dublin, Ireland (J.H.); Royal Perth Hospital, University of Western Australia (G.S.H.); StopAfib.org, Dallas, TX (M.T.H.); Weill Cornell Medical College, New York (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, UK (P.K.); SWBH and UHB NHS trusts, Birmingham, UK (P.K.); AFNET, Muenster, Germany (P.K.); Lankenau Institute for Medical Research, Wynnewood, OK (P.R.K.); University Hospital of Zurich, Switzerland (D.K.); Chinese University of Hong Kong (V.W.Y.L., B.P.Y.); University of Linköping, Sweden (L.-A.L.); University of Birmingham, UK; Aalborg University, Denmark (G.Y.H.L.); Arrhythmia Alliance, London, UK (T.L.); Charles Perkins Centre, University of Sydney, Australia (N.L.); Cliniques du Sud Luxembourg, Arlon, Belgium (G.H.M.); Institute for Epidemiology Statistics and Informatics, Frankfurt, Germany (C.M.); Edinburgh Napier University, UK (L.N.); Charles Perkins Centre, University of Sydney, Australia (J.O.); Duke University, Durham, NC (J.P.P.); University of Auckland, New Zealand (K.P.); University of Belgrade, Serbia (T.S.P.); KH der Elisabethinen, Ordensklinikum Linz, Austria (H.P.); University of Groningen, University Medical Centre Groningen, The Netherlands (M.R.); University of Alberta, Edmonton, Canada (R.K.S.); University Heart Centre, Hamburg, Germany (R.B.S.); The University of Hong Kong (C.-W.S.); Scripps Translational Science Institute, San Diego, CA (S.S.); Rigshospitalet, The Heart Centre, University of Copenhagen, Denmark (J.H.S.); Ospedale dell'Angelo Venice-Mestre, Venice, Italy (S.T.); Martini Hospital, Groningen, The Netherlands (R.G.T.); Stanford University, CA (M.P.T.); VA Palo Alto Health Care System, CA (M.P.T.); The Department of Medical Research, Bærum Hospital, Rud, Norway (A.T.); Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands (S.B.U.); University of Groningen, University Medical Centre Groningen, The Netherlands (I.C.V.G.); and University of Göttingen, Germany (R.W.).

PMID: 28483832
DOI: 10.1161/CIRCULATIONAHA.116.026693

Abstract

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

Keywords: atrial fibrillation; screening; stroke.

Publication types

Review

MeSH terms

Atrial Fibrillation / diagnosis*
Atrial Fibrillation / epidemiology*
Humans
Internationality*
Mass Screening / methods*
Risk Factors
Stroke / diagnosis
Stroke / epidemiology
Stroke / prevention & control