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Table 1 Summary of key premises for a condition to be systematically screened for in the healthy population

From: The atrial fibrillation epidemic is approaching the physician's door: will mobile technology improve detection?

Criteria for systematic AF screening1.2
AF and stroke as societal health challenges
1) AF is common, affecting approximately 5% of adults aged 65 years and older, and 10% of those older than 80 years [3]. One in four individuals is now being projected to develop the condition in their lifetime [4]. Investigators of one community survey reported a rise of 12.6% in the incidence of AF during the past 2 decades, and projected that 15.9 million people in the USA will have the disorder by 2050 [5]
2) AF increases the risk for ischemic stroke by approximately fivefold. In the UK, findings from the SAFE study [6] showed a baseline prevalence of AF of 7.2% in patients aged 65 years and older, with an increased prevalence in men (7.8%) and in those aged 75 years and older (10.3%), and a yearly incidence of new AF of about 1.6%. AF causes 15% of all strokes, and 30% of those whose strokes occur after the age of 80 years in the US population [3],[4]
3) AF constitutes a public health burden by triggering prevalent embolic strokes, and it frequently leads to impaired quality of life, resulting in high healthcare costs. The cost of stroke is substantial. In the UK, mean censor-adjusted 5-year hospital costs after stroke were $25,741 [7], but the lifetime costs have been estimated to be substantially higher; for example, $130,000 after ischemic stroke in Finland [8]
Possibilities for AF screening
4) Individuals of advanced age - for example, 70 and 80 years old -are a suitable target population for screening, as the incidence of AF at older ages is substantial
5) There is an early or latent stage, in which patients with AF are commonly asymptomatic, but they may progress to manifest cardiac problems and sudden cardioembolism and stroke. Further, AF may be preceded by subclinical atrial tachyarrhythmias, which are associated with significantly increased risk of stroke and systemic embolism [9]
6) The diagnosis is simple using widely available, non-invasive tools such as ECG and Holter-ECG
Recommendations for treatment
7) There are already agreed policies in place for treatment of incidental AF in asymptomatic individuals, or in patients following symptoms or stroke. Several accepted interventions are available, which can correct the underlying cardiac rhythm disturbance of AF, including pharmacologic cardioversion, electrical cardioversion, and catheter ablation [10]
8) Scoring systems (for example, the CHA2DS2-VASc score) detailed in consensus guidelines are in place to individually guide the initiation of oral OACs in order to decrease the risk of subsequent AF-related new ischemic strokes [11]. OACs produce marked reductions in strokes; for example, up to 64% for warfarin and an estimated 77% for dabigatran compared with placebo [11]
9) Several novel OACs, such as dabigatran, rivaroxaban and apixaban, are available, which probably reduces the threshold of initiating long-term therapy to reduce cardioembolic strokes [12]-[15].
Risks and benefits
10) Potential risks of screening include development of serious hemorrhagic complications in some patients prescribed OACs.
11) Scientific evidence for the benefits and effectiveness of screening programs is still being produced. It has not yet been demonstrated that systematic screening for AF improves outcome
  1. AF atrial fibrillation, ECG electrocardiogram, OAC oral anti-coagulant, SAFE Screening for Atrial Fibrillation in the Elderly.