Experts recommend screening for AF in older people to cut risk of stroke and death

Screening for asymptomatic atrial fibrillation (AF) in people aged 65 and over and treating it with anticoagulant medications could prevent many thousands of strokes worldwide each year, say a top-level panel of experts in today’s issue of Circulation, the journal of the American Heart Association.

An international collaboration, AF-SCREEN, is behind a global push to introduce national screening programs for the common heart condition atrial fibrillation (AF), which triggers catastrophic strokes.

AF is a common and serious heart arrhythmia accounting for one in three strokes. This happens because the abnormal heart rhythm poses the risk of blood clots forming inside the heart. When clots break off they usually travel to the brain, causing severe strokes.

About 10 percent of ischemic strokes are caused by AF that is first detected at the time of stroke. Asymptomatic AF which underlies these strokes is not uncommon and can be easily detected by simply taking the pulse, or by handheld ECGs which provide a diagnosis in less than a minute.

Professor Julian Halcox

 “Strokes from AF are larger, more severe and harder to survive than other strokes,” says Professor Julian Halcox, Consultant Cardiologist at ABMU Health Board and Professor of Cardiology at Swansea University Medical School. “To be able to protect vulnerable people from ever experiencing one will spare them and their families a lot of heartache.”

Statistics from the World Heart Federation show 15 million people have a stroke each year, nearly six million die and another five million are left permanently disabled.

“Widespread screening for asymptomatic atrial fibrillation in people aged 65 years and above could cost-effectively reduce strokes and their associated disability, and help save lives,” says Professor Halcox, “However, this is not yet widely recommended in guidelines”.

 

Professor Julian Halcox, Swansea University Medical School

Professor Halcox is a member of AF-SCREEN International Collaboration, comprising over 130 cardiologists, neurologists, GPs, health economists, nurses, pharmacists and patient support organisations from 33 countries. The White Paper was written by 60 AF-SCREEN members.

“There is also good evidence that finding asymptomatic AF before symptoms develop, and treating it with oral anticoagulants and other therapies, could greatly reduce the increased risk of stroke, and partially reverse the increased risk of associated death,” he says.

Screening has been shown to detect undiagnosed AF in one to three per cent of people aged over 65 to 75 years of age.

Given how easy it is to detect AF, and the demonstration of the poor outcomes that can be substantially modified by treatment, AF-SCREEN believe there is a reasonable, cost-effective case to screen for this abnormal heart rhythm in older people in the community, as well as in the clinic.

The White Paper calls for governments worldwide to introduce screening for all older people, at age 65 or possibly older. Programs could be run through GPs, pharmacies or in the community, and could be carried out with pulse checking, a blood pressure monitor or, ideally, a handheld ECG device, the best tool for rapidly offering a firm AF diagnosis.

Those with concerns about their heartbeat and stroke risk can take action. “If you are aged 65 years or over, then you can see your doctor to check your pulse, or check your own at home to see if it’s regular like a clock,” adds Professor Halcox. “If it’s irregular you can have an ECG and get your AF diagnosed and medicated.”

Trudie Lobban MBE, CEO & Founder Arrhythmia Alliance, and a member of the AF-Screen collaboration, said: “Globally there are 33 million people with undiagnosed AF, who are at risk of suffering a debilitating, life-threatening AF-related stroke. Arrhythmia Alliance, together with AF Association and the AF-Screen, are calling on Governments worldwide to introduce AF screening programmes and prevent the many thousands of unnecessary deaths from AF-related strokes. We welcome the publication of this important White Paper which confirms the unquestionable value of a national screening programme for AF in people aged 65 and over.”

Fast Facts on Atrial fibrillation, screening and treatment

  • Atrial fibrillation (AF) is responsible for one third of all strokes.
  • 27 per cent of AF-related strokes (amounting to 10% of all strokes) aren’t detected prior to stroke because AF is often asymptomatic (no apparent symptoms and unrecognised by the person with AF)
  • AF-related strokes are more severe and cause greater disability than non-AF strokes
  • Widespread screening for asymptomatic AF among people aged 65 years and over would be a potent way to prevent strokes and the burden of stroke-related harm because AF-related strokes are largely preventable by treatment with oral anticoagulant drugs.
  • It is time to include AF screening in more national and continental guidelines worldwide.

AF-SCREEN International Collaboration website; www.afscreen.org

The White Paper, Screening for Atrial Fibrillation, A Report of the AF-SCREEN International Collaboration, has 60 contributing authors.

Circulation May 9th 2017 issue 19; Vol 135;