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Screening strategies for atrial fibrillation in the elderly population: a systematic review and network meta-analysis

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Abstract

Opportunistic screening for atrial fibrillation (AF) is currently recommended for patients aged 65 years and older. However, this has recently been called into question by two studies that report that opportunistic screening is no more effective than usual care. Furthermore, there seems to be no consensus on which is the most effective screening strategy (opportunistic or systematic). Thus, we aimed to compare the different AF detection strategies with each other using the methodology of systematic review with network meta-analysis. An electronic database search of MEDLINE, CENTRAL, and EMBASE was performed. In addition, we also searched OpenGrey, experts’ knowledge and screened the reference list of included studies or other relevant publications. The search was performed on the 2nd of November of 2020 and updated on the 20th of September of 2021. We performed a random-effects pairwise meta-analysis and a random-effects network meta-analysis within a frequentist framework in an intention to screen analysis. We reported the results as relative risk (RR) with 95% confidence intervals (CI). We assessed the confidence in the evidence using the GRADE framework. Nine studies were included, enrolling 80,665 participants. Pooled effect sizes suggested that systematic screening was effective when compared with usual care (RR 2.11; 95% CI 1.48–3.02; high GRADE confidence) and when compared with opportunistic screening (RR 1.86; CI 1.23–2.82; high GRADE confidence) but no significant difference was found between opportunistic screening and usual care (RR 1.13; 95% CI 0.79–1.63; low GRADE confidence). Systematic screening was the most effective strategy for detecting atrial fibrillation in individuals aged 65 years or older. Opportunistic screening was no more effective than usual care, but the results were weakened by a low quality of evidence due to risk of bias of the included studies and imprecision in the results. PROSPERO registration number: CRD42020218672.

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Funding

This project was funded by “Programa Educação pela Ciência” (PEC).

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Authors and Affiliations

  1. Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal

    Rafael Whitfield, Raquel Ascenção, Gustavo Lima da Silva, Ana G. Almeida, Fausto J. Pinto & Daniel Caldeira

  2. Clínica Universitária de Medicina Geral e Familiar, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal

    Raquel Ascenção

  3. Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal

    Gustavo Lima da Silva, Ana G. Almeida, Fausto J. Pinto & Daniel Caldeira

  4. Serviço de Cardiologia, Departamento do Coração e Vasos, Hospital Universitário de Santa Maria-CHULN, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal

    Gustavo Lima da Silva, Ana G. Almeida, Fausto J. Pinto & Daniel Caldeira

  5. Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal

    Daniel Caldeira

  6. Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal

    Daniel Caldeira

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Daniel Caldeira has participated in educational meetings and/or attended conferences or symposia (including travel, accommodation, and/or hospitality) with Bristol-Myers Squibb, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Merck Serono, Ferrer, Pfizer, Novartis, and Roche. The remaining authors do not have interests to disclose.

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Whitfield, R., Ascenção, R., da Silva, G.L. et al. Screening strategies for atrial fibrillation in the elderly population: a systematic review and network meta-analysis. Clin Res Cardiol 112, 705–715 (2023). https://doi.org/10.1007/s00392-022-02117-9

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