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Screening for Atrial Fibrillation

2017; Lippincott Williams & Wilkins; Volume: 135; Issue: 19 Linguagem: Inglês

10.1161/circulationaha.116.026693

1524-4539

Ben Freedman, A. John Camm, Hugh Calkins, Jeff S. Healey, Mårten Rosenqvist, Ji‐Guang 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 Fitzmaurice, Leif Friberg, Bernard J. Gersh, David J. Gladstone, Taya V. Glotzer, Kylie Gwynne, Graeme J. Hankey, Joseph Harbison, Graham S. Hillis, Mellanie True Hills, Hooman Kamel, Paulus Kirchhof, Peter R. Kowey, Derk Krieger, Vivian Lee, Lars‐Åke Levin, Gregory Y. H. Lip, Trudie Lobban, Nicole Lowres, Georges H. Mairesse, Carlos Martínez, Lis Neubeck, J. Orchard, Jonathan P. Piccini, Katrina Poppe, Tatjana Potpara, Helmut Püererfellner, Michiel Rienstra, Roopinder K. Sandhu, Renate B. Schnabel, Chung-Wah Siu, Steven R. Steinhubl, Jesper Hastrup Svendsen, Emma Svennberg, Sakis Themistoclakis, Robert G Tieleman, Mintu P. Turakhia, Arnljot Tveit, Steven B Uittenbogaart, Isabelle C. Van Gelder, Atul Kumar Verma, Rolf Wachter, Bryan P. Yan, Amjad Awwad, F Al-Kalili, T. Berge, Günter Breithardt, Gerard Bury, WR Caorsi, NY Chan, SA Chen, Ingrid E. Christophersen, Stuart J. Connolly, H Crijns, S.A. Davis, Ulrik Dixen, R. Doughty, Xianfeng Du, Michael D. Ezekowitz, M. Fay, Viveka Frykman, M Geanta, Henry Gray, N. Grubb, Andres Guerra, Julian Halcox, Róbert Hatala, H Heidbuchel, Rod Jackson, Linda Johnson, S. Kääb, Katherine Keane, Yang‐Hyun Kim, G Kollios, Maja‐Lisa Løchen, C Ma, J Mant, Martin Martinek, Irene Marzona, Kenji Matsumoto, D. McManus, Patrick Moran, N. Naik, Tachapong Ngarmukos, Dorairaj Prabhakaran, D Reidpath, Antônio Luiz Pinho Ribeiro, A. G. Rudd, I Savalieva, Richard J. Schilling, M Sinner, Simon Stewart, Nijasri C. Suwanwela, N. Takahashi, E Topol, S Ushiyama, Nicole Verbiest-van Gurp, Natalie Walker, Tissa Wijeratne,

Acute Ischemic Stroke Management

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.