"The Lancet" Sub-Journal: This "silent" pusher for stroke prevention recommends quarterly screening

Atrial fibrillation is a common heart rhythm problem.

Atrial fibrillation is associated with a nearly five-fold increase in the risk of ischemic stroke, and approximately 10% of ischemic strokes are related to atrial fibrillation first diagnosed at the time of the stroke

In 2017, the "Atrial Fibrillation Screening" report written by 60 members of the AF-SCREEN International Cooperation Group around the world recommended that asymptomatic elderly people over 65 should be screened for atrial fibrillation

The AF-CATCH (Quarterly and Annual Electrocardiogram Screening for Chinese Elderly Atrial Fibrillation) study led by Professor Wang Jiguang, Director of the Department of Hypertension of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Director of Shanghai Institute of Hypertension The general population, such as those aged ≥65 years, can consider screening every quarter

A review article published in the same journal "The Lancet-Aging Health" pointed out that "the study was well executed and the question of the optimal screening frequency was answered in a randomized trial

The AF-CATCH study aims to evaluate whether more frequent ECG screening can improve the detection of atrial fibrillation compared to annual ECG screening

The follow-up ended on October 31, 2020.

None of these subjects had a history of atrial fibrillation or atrial fibrillation rhythm when they joined the study

There were 26 cases in the annual screening group, with a total detection rate of 4.

▲Cumulative incidence of atrial fibrillation in the two quarterly screening groups (red line) and annual screening group (blue line) (picture source: reference [1])

The above results are similar regardless of the patient's age (65-74 years vs ≥75 years), gender, body mass index (≤25 vs >25), history of hypertension or diabetes, or history of cardiovascular disease

A further comparison of the two quarterly screening strategies found:

A total of 40 cases occurred in the quarterly screening group, and the total detection rate was 7.

It is worth noting that the study also revealed a serious public health challenge facing China-the inadequate treatment of atrial fibrillation in the community

The research team concluded that this randomized controlled trial showed that in the elderly in China, compared with the 30-second single-lead ECG screening once a year, quarterly screening can significantly increase the detection rate of atrial fibrillation, but in every An additional weekly screening in the first month of the quarter did not bring further predictive value

At the same time, in view of the low rate of oral anticoagulation treatment for patients with atrial fibrillation in China, before this intensive screening strategy is more widely recommended, this strategy needs to be further evaluated in a larger population, while increasing the rate of oral anticoagulation treatment for patients with known atrial fibrillation

The concurrent review article also emphasized the importance of preventive treatment of stroke in newly discovered patients with atrial fibrillation after screening

Note: The original text has been deleted

Reference

[1] Wei Zhang, et al.

[2] David Duncker, Emma Svennberg.
The catch in atrial fibrillation detection: don't forget to treat.
The Lancet Healthy Longevity, DOI: https://doi.
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[3] China Cardiovascular Health and Disease Report Writing Group.
(2021).
Summary of China Cardiovascular Health and Disease Report 2020.
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[4] Freedman B, Camm J, Calkins H, et al.
(2017).
Screening for Atrial Fibrillation: A Report of the AF-SCREEN International Collaboration.
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