Yield of Atrial Fibrillation Screening according to Methodology and Patient Characteristics: An Individual Participant Data Meta-Analysis of 34,165 Individuals Screened for Atrial Fibrillation within the AFFECT-EU/AF-SCREEN Collaboration.
TL;DR
The findings support tailoring the screening approach to the individual target population in clinical practice, and were independently associated with greater AF detection, particularly in those having single-timepoint screening.
Abstract
BACKGROUNDS AND
Aims
Atrial fibrillation (AF) screening may reduce adverse outcomes through early initiation of preventive treatment. However, more data are warranted to inform the yield of different screening strategies. This study aimed to evaluate how patient characteristics and screening methodologies influence screening yield.
Methods
We conducted an individual participant data meta-analysis of 12 European and North American study cohorts, by using generalized linear mixed models with random intercept at study level.
Results
In this meta-analysis of 34,165 participants screened for AF (age 73.4 ± 7.5 years and 53.5% female), the screening yield increased with more intensive approaches, ranging from 0.83% [95% confidence interval (CI): 0.24-2.87] in single-timepoint screening, to 5.06% [95% CI: 3.55-7.17] in intermittent (i.e. repeated single-timepoint) screening, 4.81% [95% CI: 3.79-6.08] in short-term continuous monitoring (≤30 days), and up to 30.39% [95% CI: 28.06-32.84] in long-term continuous monitoring (>30 days). Advanced age, male sex, hypertension, and heart failure (HF) were associated with detection. Significant interactions were observed between screening approach and age, sex, HF, CHADS2, and NT-proBNP. These risk factors had a stronger influence on AF detection with single-timepoint screening, compared with more intensive methods.
Conclusions
In this meta-analysis, AF screening yield varied substantially by patient characteristics and screening approach. Advanced age, male sex, and HF were independently associated with greater AF detection, particularly in those having single-timepoint screening. Our findings support tailoring the screening approach to the individual target population in clinical practice. Further studies to assess clinical outcomes following screening are needed and underway.