Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

Screening for atrial fibrillation: A Report of the AF-SCREEN International Collaboration / Ben, Freedman; John, Camm; Hugh, Calkins; Jeffrey, S. Healey; Mårten, Rosenqvist; Jiguang, Wang; Christine, M. Albert; Craig, S. Anderson; Sotiris, Antoniou; Emelia, J. Benjamin; Boriani, Giuseppe; Johannes, Brachmann; Axel, Brandes; Tze Fan, Chao; David, Conen; Johan, Engdahl; Laurent, Fauchier; David, A. Fitzmaurice; Leif, Friberg; Bernard, J. Gersh; David, J. Gladstone; Taya, V. Glotzer; Kylie, Gwynne; Graeme, J. Hankey; Joseph, Harbison; Graham, S. Hillis; Mellanie, T. Hills; Hooman, Kamel; Paulus, Kirchhof; Peter, R. Kowey; Derk, Krieger; Vivian, W. Y. Lee; Lars Åke, Levin; Gregory, Y. H. Lip; Trudie, Lobban; Nicole, Lowres; Georges, H. Mairesse; Carlos, Martinez; Lis, Neubeck; Jessica, Orchard; Jonathan, P. Piccini; Katrina, Poppe; Tatjana, S. Potpara; Helmut, Puererfellner; Michiel, Rienstra; Roopinder, K. Sandhu; Renate, B. Schnabel; Chung Wah, Siu; Steven, Steinhubl; Jesper, H. Svendsen; Emma, Svennberg; Sakis, Themistoclakis; Robert, G. Tieleman; Mintu, P. Turakhia; Arnljot, Tveit; Steven, B. Uittenbogaart; Isabelle, C. Van Gelder; Atul, Verma; Rolf, Wachter; Bryan, P. Yan. - In: CIRCULATION. - ISSN 0009-7322. - 135:19(2017), pp. 1851-1867. [10.1161/CIRCULATIONAHA.116.026693]

Screening for atrial fibrillation: A Report of the AF-SCREEN International Collaboration

BORIANI, Giuseppe;
2017

Abstract

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.
2017
135
19
1851
1867
Screening for atrial fibrillation: A Report of the AF-SCREEN International Collaboration / Ben, Freedman; John, Camm; Hugh, Calkins; Jeffrey, S. Healey; Mårten, Rosenqvist; Jiguang, Wang; Christine, M. Albert; Craig, S. Anderson; Sotiris, Antoniou; Emelia, J. Benjamin; Boriani, Giuseppe; Johannes, Brachmann; Axel, Brandes; Tze Fan, Chao; David, Conen; Johan, Engdahl; Laurent, Fauchier; David, A. Fitzmaurice; Leif, Friberg; Bernard, J. Gersh; David, J. Gladstone; Taya, V. Glotzer; Kylie, Gwynne; Graeme, J. Hankey; Joseph, Harbison; Graham, S. Hillis; Mellanie, T. Hills; Hooman, Kamel; Paulus, Kirchhof; Peter, R. Kowey; Derk, Krieger; Vivian, W. Y. Lee; Lars Åke, Levin; Gregory, Y. H. Lip; Trudie, Lobban; Nicole, Lowres; Georges, H. Mairesse; Carlos, Martinez; Lis, Neubeck; Jessica, Orchard; Jonathan, P. Piccini; Katrina, Poppe; Tatjana, S. Potpara; Helmut, Puererfellner; Michiel, Rienstra; Roopinder, K. Sandhu; Renate, B. Schnabel; Chung Wah, Siu; Steven, Steinhubl; Jesper, H. Svendsen; Emma, Svennberg; Sakis, Themistoclakis; Robert, G. Tieleman; Mintu, P. Turakhia; Arnljot, Tveit; Steven, B. Uittenbogaart; Isabelle, C. Van Gelder; Atul, Verma; Rolf, Wachter; Bryan, P. Yan. - In: CIRCULATION. - ISSN 0009-7322. - 135:19(2017), pp. 1851-1867. [10.1161/CIRCULATIONAHA.116.026693]
Ben, Freedman; John, Camm; Hugh, Calkins; Jeffrey, S. Healey; Mårten, Rosenqvist; Jiguang, Wang; Christine, M. Albert; Craig, S. Anderson; Sotiris, Antoniou; Emelia, J. Benjamin; Boriani, Giuseppe; Johannes, Brachmann; Axel, Brandes; Tze Fan, Chao; David, Conen; Johan, Engdahl; Laurent, Fauchier; David, A. Fitzmaurice; Leif, Friberg; Bernard, J. Gersh; David, J. Gladstone; Taya, V. Glotzer; Kylie, Gwynne; Graeme, J. Hankey; Joseph, Harbison; Graham, S. Hillis; Mellanie, T. Hills; Hooman, Kamel; Paulus, Kirchhof; Peter, R. Kowey; Derk, Krieger; Vivian, W. Y. Lee; Lars Åke, Levin; Gregory, Y. H. Lip; Trudie, Lobban; Nicole, Lowres; Georges, H. Mairesse; Carlos, Martinez; Lis, Neubeck; Jessica, Orchard; Jonathan, P. Piccini; Katrina, Poppe; Tatjana, S. Potpara; Helmut, Puererfellner; Michiel, Rienstra; Roopinder, K. Sandhu; Renate, B. Schnabel; Chung Wah, Siu; Steven, Steinhubl; Jesper, H. Svendsen; Emma, Svennberg; Sakis, Themistoclakis; Robert, G. Tieleman; Mintu, P. Turakhia; Arnljot, Tveit; Steven, B. Uittenbogaart; Isabelle, C. Van Gelder; Atul, Verma; Rolf, Wachter; Bryan, P. Yan
File in questo prodotto:
File Dimensione Formato  
CIRCULATIONAHA.116.026693.pdf

Open access

Tipologia: Versione pubblicata dall'editore
Dimensione 282.05 kB
Formato Adobe PDF
282.05 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1139441
Citazioni
  • ???jsp.display-item.citation.pmc??? 173
  • Scopus 425
  • ???jsp.display-item.citation.isi??? 399
social impact