Screening For Asymptomatic Atrial Fibrillation: Its Effectiveness And Cost-Effectiveness Of Repeated Ecg In Poland

Atrial fibrillation (AF) is the most common arrhythmia in humans. AF increases the risk of ischemic stroke up to 5-fold. Fortunately, this is highly preventable with appropriate oral anticoagulant (OAC) therapy. However, many patients with AF, despite the presence of risk factors, are not taking OACs, because they are not aware of the occurrence of arrhythmia prior to stroke. Therefore, it seems that the screening for AF in a broad population aimed at the earliest possible detection of asymptomatic arrhythmias, and the implementation of OAC treatment when necessary, could prevent many strokes. To assess the effectiveness of active screening for previously undiagnosed AF when compared to the standard care as well as to estimate the cost-effectiveness of repeated ECG in comparison with the lack of screening in Polish population with average risk of AF. We searched multiple databases for studies comparing systematic or opportunistic screening using ECG or pulse palpation, compared to no screening in populations age ≥40 years living in community or attending GP practices. The primary outcome was the incidence of previously undiagnosed AF. The cost-effectiveness analysis of screening in 67-year-old individuals was based on a lifelong decision analytic Markov model. 1056 articles were found and 23 that fulfilled our inclusion criteria were taken into meta-analysis (n=83 323, mean age 64.3, 48.4% males). The incidence of newly detected, clinically silent, AF was 1.5% (95% CI 1.1-1.9%). In the base-case scenario, screening of 1000 individuals resulted in 7 more quality-adjusted life-years (QALYs) and 2 fewer strokes. ICER was 74 001 PLN per one stroke prevented. It has been shown that active screening for undiagnosed AF is more effective than standard care and that screening with the use of repeated ECG in 67-year old individuals may be cost-effective in Poland.