RT Journal Article
T1 Estimated stroke risk, yield, and number needed to screen for atrial fibrillation detected through single time screening: a multicountry patient-level meta-analysis of 141,220 screened individuals.
A1 Lowres, Nicole
A1 Olivier, Jake
A1 Chao, Tze-Fan
A1 Chen, Shih-Ann
A1 Chen, Yi
A1 Diederichsen, Axel
A1 Fitzmaurice, David A
A1 Gomez-Doblas, Juan Jose
A1 Harbison, Joseph
A1 Healey, Jeff S
A1 Hobbs, F D Richard
A1 Kaasenbrood, Femke
A1 Keen, William
A1 Lee, Vivian W
A1 Lindholt, Jes S
A1 Lip, Gregory Y H
A1 Mairesse, Georges H
A1 Mant, Jonathan
A1 Martin, Julie W
A1 Martín-Rioboó, Enrique
A1 McManus, David D
A1 Muñiz, Javier
A1 Münzel, Thomas
A1 Nakamya, Juliet
A1 Neubeck, Lis
A1 Orchard, Jessica J
A1 Perula de Torres, Luis Angel
A1 Proietti, Marco
A1 Quinn, F Russell
A1 Roalfe, Andrea K
A1 Sandhu, Roopinder K
A1 Schnabel, Renate B
A1 Smyth, Breda
A1 Soni, Apurv
A1 Tieleman, Robert
A1 Wang, Jiguang
A1 Wild, Philipp S
A1 Yan, Bryan P
A1 Freedman, Ben
K1 Adult
K1 Aged, 80 and over
K1 Female
K1 Mass Screening
K1 Prognosis
K1 Sex Factors
AB The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation (AF) is not known. Therefore, it is not possible to determine the number needed to screen (NNS) to identify one treatable new AF case (NNS-Rx) (i.e., Class-1 oral anticoagulation [OAC] treatment recommendation) in each age stratum. If the NNS-Rx is known for each age stratum, precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population/region to be screened. Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded. Therefore, we aimed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata. A systematic review of Medline, Pubmed, and Embase was performed (January 2007 to February 2018), and AF-SCREEN international collaboration members were contacted to identify additional studies. Twenty-four eligible studies were identified that performed a single time point screen for AF in a general ambulant population, including people ≥65 years. Authors from eligible studies were invited to collaborate and share patient-level data. Statistical analysis was performed using random effects logistic regression for AF detection rate, and Poisson regression modelling for CHA2DS2-VASc scores. Nineteen studies (14 countries from a mix of low- to middle- and high-income countries) collaborated, with 141,220 participants screened and 1,539 new AF cases. Pooled yield of screening was greater in males across all age strata. The age/sex-adjusted detection rate for screen-detected AF in ≥65-year-olds was 1.44% (95% CI, 1.13%-1.82%) and 0.41% (95% CI, 0.31%-0.53%) for  People with screen-detected AF are at elevated calculated stroke risk: above age 65, the majority have a Class-1 OAC recommendation for stroke prevention, and >70% have ≥1 additional stroke risk factor other than age/sex. Our data, based on the largest number of screen-detected AF collected to date, show the precise relationship between yield and estimated stroke risk profile with age, and strong dependence for NNS-RX on the age distribution of the population to be screened: essential information for precise cost-effectiveness calculations.
PB Public Library of Science
YR 2019
FD 2019-08-21
LK http://hdl.handle.net/10668/14545
UL http://hdl.handle.net/10668/14545
LA en
NO Lowres N, Olivier J, Chao TF, Chen SA, Chen Y, Diederichsen A, et al. Estimated stroke risk, yield, and number needed to screen for atrial fibrillation detected through single time screening: a multicountry patient-level meta-analysis of 141,220 screened individuals. PLoS Med. 2019 Sep 25;16(9):e1002903.
DS RISalud
RD Apr 19, 2025