Ali Wahab , Ramesh Nadarajah , Harriet Larvin , Maryum Farooq , Keerthenan Raveendra , Mohammad Haris , Umbreen Nadeem , Tobin Joseph , Asad Bhatty , Chris Wilkinson , Kamlesh Khunti , Rajesh Vedanthan , A John Camm , Emma Svennberg , Gregory YH. Lip , Ben Freedman , Jianhua Wu , Chris P. Gale
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引用次数: 0
Abstract
Background
Systematic screening individuals with non-invasive devices may improve diagnosis of atrial fibrillation (AF) and reduce adverse clinical events. We systematically reviewed the existing literature to determine the yield of new AF diagnosis associated with systematic AF screening, the relative increase in yield of new AF diagnosis with systematic screening compared to usual care, and the effect of systematic AF screening on clinical outcomes compared with usual care.
Methods
The Medline, Embase, Web of Science and Cochrane Library databases were searched from inception through 1st February 2025 for prospective cohort studies or randomised clinical trials (RCTs) of systematic AF screening with the outcome of incidence of previously undiagnosed AF from screening. Incidence rates (IR) and relative risks were calculated and random effects meta-analysis performed to synthesise rates of AF in prospective cohort studies and RCTs, as well as outcomes in RCTs.
Findings
From 3806 unique records we included 32 studies representing 735,542 participants from 8 RCTs and 24 prospective cohorts. The diagnosis rate for incident AF in prospective cohorts was 2.75% (95% CI 1.87–3.62), and the pooled relative risk in RCTs was 2.22 (95% CI 1.41–3.50). The use of age and NT-proBNP (IR 4.36%, 95% CI 3.77–5.08) or AF risk score classification (4.79%, 95% CI 3.62–6.29) led to higher new AF diagnosis yields than age alone (0.93%, 95% CI 0.28–2.99). Pooled data from RCTs did not demonstrate an effect of screening on death (RR 1.01, 95% CI 0.97–1.05), cardiovascular hospitalisation (1.00, 95% CI 0.97–1.03), stroke (0.95, 95% CI 0.87–1.04) or bleeding (1.08, 95% CI 0.91–1.29).
Interpretation
Systematic screening for AF using non-invasive devices is associated with increased diagnosis of AF, but not reduced adverse clinical events. Screening studies of AF utilising alternative risk stratifications and outcome measures are required.
Funding
British Heart Foundation (grant reference CC/22/250026) and National Institute for Health and Care Research.
背景：使用无创设备系统筛查个体可以提高房颤（AF）的诊断并减少不良临床事件。我们系统地回顾了现有文献，以确定与系统房颤筛查相关的房颤新诊断率，与常规护理相比，系统房颤筛查对房颤新诊断率的相对增加，以及与常规护理相比，系统房颤筛查对临床结局的影响。方法检索Medline、Embase、Web of Science和Cochrane Library数据库，从建立到2025年2月1日，检索系统性房颤筛查的前瞻性队列研究或随机临床试验（rct），以及筛查中先前未诊断房颤的发生率。计算发病率（IR）和相对风险，并进行随机效应荟萃分析，以综合前瞻性队列研究和随机对照试验中房颤的发生率以及随机对照试验的结果。从3806个独特的记录中，我们纳入了32项研究，来自8个随机对照试验和24个前瞻性队列的735,542名参与者。前瞻性队列中AF的诊断率为2.75% (95% CI 1.87-3.62)，随机对照试验中合并相对危险度为2.22 （95% CI 1.41-3.50）。使用年龄和NT-proBNP （IR 4.36%, 95% CI 3.77-5.08）或AF风险评分分类（4.79%,95% CI 3.62-6.29）导致AF新诊断率高于单独使用年龄（0.93%,95% CI 0.28-2.99）。来自随机对照试验的汇总数据未显示筛查对死亡（RR 1.01, 95% CI 0.97-1.05）、心血管住院（1.00,95% CI 0.97-1.03）、卒中（0.95,95% CI 0.87-1.04）或出血（1.08,95% CI 0.91-1.29）的影响。解释：使用无创设备系统筛查房颤与房颤诊断率增加相关，但不能减少不良临床事件。需要使用替代风险分层和结果测量对房颤进行筛查研究。资助英国心脏基金会（批准编号CC/22/250026）和国家卫生和保健研究所。
期刊介绍：
The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.
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