USPSTF: Current Evidence Insufficient to Recommend For or Against Atrial Fibrillation Screening

Current evidence is insufficient to recommend for or against screening for atrial fibrillation (AF), according to a new recommendation statement released by the US Preventive Services Task Force (USPSTF) and published in JAMA.

“Unfortunately, there still is not enough evidence to know if screening for AFib helps to prevent strokes in older adults,” said USPSTF member Gbenga Ogedegbe, MD, MPH, in a press release. “Since AFib is a risk factor for stroke and can go undetected, clinicians should use their best judgment to decide whether or not to screen people without signs or symptoms of AFib.”

In fact, according to the Task Force statement, approximately 20% of patients who present with AF-associated stroke are first diagnosed with the arrhythmia at the time of the event or soon after.

To update its 2018 recommendation, the USPSTF commissioned a systematic review on the benefits and harms of screening for the arrhythmiain adults aged ≥50 years without a diagnosis or symptoms of AF and without a history of transient ischemic attack or stroke.

In particular, the review addressed the accuracy of screening tests; the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care; and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older patients.

The final “I Statement” concluded, “that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF,” which is consistent with the 2018 USPSTF recommendation on screening for AF with electrocardiography.

“The Task Force expanded the scope of this review to look for evidence on emerging technologies that could help us reach a conclusion about the balance of benefits and harms of screening for AFib,” said USPSTF vice-chair Carol Mangione, MD, MSPH, in the press release. “But even with these new technologies, there is not enough evidence on whether screening for AFib helps prevent strokes, so we are calling for more research on this important health issue.”

The USPSTF called for additional studies to address outstanding issues, including:

• Randomized trials enrolling asymptomatic persons that directly compare screening with usual care and that assess both health outcomes and harms are needed to understand the balance of benefits and harms of screening for AF.
• Means to optimize the accuracy of screening tests and strategies for AF.
• Improving understanding of the risk of stroke associated with subclinical AF, or AF detected with use of consumer devices; how that risk varies with duration or burden of AF; and the potential benefit of anticoagulation therapy among persons with subclinical AF.

The statement acknowledges that the American Heart Association and American Stroke Association support active AF screening in primary care settings for those aged ≥65 years via pulse assessment and followed by ECG. The American Academy of Family Physicians supports screening for AF with ECG, a recommendation included in the 2018 USPSTF recommendation.

Reference: US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for atrial fibrillation: US Preventive Services Task Force recommendation statement. JAMA. 2022;327:360-367.