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USPSTF: Evidence Lacking for A-Fib Screening in Asymptomatic Seniors

WEDNESDAY, April 21, 2021 -- The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to weigh the balance of benefits and harms of screening for atrial fibrillation (AF) in older adults (I statement). These findings form the basis of a draft recommendation statement, published online April 20.

Leila Kahwati, M.D., M.P.H., from the RTI International-University of North Carolina at Chapel Hill Evidence-Based Practice Center in Research Triangle Park, and colleagues reviewed the evidence on screening for AF in older adults. Data were included from 24 studies. The researchers found that events were rare and findings imprecise in one randomized controlled trial (RCT) involving 1,001 participants comparing screening with twice-weekly intermittent single-lead electrocardiography (ECG) for 12 months versus no screening. In five RCTs assessing different ECG screening strategies, more cases of AF were detected compared with no screening, with larger between-group differences for intermittent or continuous ECG versus one-time testing. Two RCTs comparing one-time ECG screening with pulse palpitation showed no difference in cases detected. In one cohort study, initiation of anticoagulation, antiarrhythmics, and procedures was higher among participants receiving screening, but the health outcomes and potential harms of treatment were not reported.

Based on these findings, the USPSTF concludes that the current evidence is lacking and the balance of benefits and harms of screening for AF cannot be ascertained. These findings apply to adults aged 50 years and older without a diagnosis or symptoms of AF.

The draft recommendation statement and evidence review have been posted for public comment; comments can be submitted from April 20 through May 17, 2021.

Draft Evidence Review

Draft Recommendation Statement

Comment on Recommendation Statement

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