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.