Benefits and Harms of Screening
There is 30% first year mortality rate amongst AF patients who have
stroke and another 30% are permanently disabled.43Therefore, one would expect that there is merit in detecting AF cases
early in the course at the stage of paroxysmal and subclinical stage
before considerable remodeling has occurred to allow for a higher
likelihood of spontaneous conversion, early OAC to prevent strokes, and
overall better outcomes for patients.44 Meta-analyses
data consistently show lower risk of primary composite outcomes of
stroke and emboli in AF patients treated with warfarin and direct acting
OAC.45-47
Implementation of a risk modification plan (such as weight reduction,
decreasing alcohol intake, treatment of obstructive sleep apnea) in
patients identified to be at a future high risk of developing AF could
also alter the overall outcomes.48 Especially as
considerable research efforts to identify risk factors of AF are
transpiring, an effective screening plan could eventually become
crucial.
Lastly, another important consideration is harm from screening which is
not extensively studied.49 Potential harms include
misinterpretation of ECGs, with false positive results leading to
unnecessary testing and treatment with OAC. Additionally, with
increasing screening modalities being employed, anticoagulation rates
are bound to increase and thus, there is a need to be mindful of
increased bleeding risk.49
Ideally, the screening modality needs to be cheap, widely available,
non-invasive and non-cumbersome for the patient. Stratifying patients
who are at higher risk is likely beneficial to increase diagnostic yield
of any modality, to be cost effective and reduce unnecessary testing and
distress to patients. Thus, having a tool which can make prediction of
incident AF using only a 12 SL ECG has potential to affect patient
outcomes.