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

被引:1
作者
Whitfield, Rafael [1 ]
Ascencao, Raquel [1 ,2 ]
da Silva, Gustavo Lima [1 ,3 ,4 ]
Almeida, Ana G. [1 ,3 ,4 ]
Pinto, Fausto J. [1 ,3 ,4 ]
Caldeira, Daniel [1 ,3 ,4 ,5 ,6 ]
机构
[1] Univ Lisbon, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal
[2] Univ Lisbon, Clin Univ Med Geral & Familiar, Inst Med Prevent & Saude Publ, Fac Med, Lisbon, Portugal
[3] Univ Lisbon, Ctr Cardiovasc Univ Lisboa CCUL CCUL RISE, Fac Med, CAML, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal
[4] Hosp Univ Santa Maria CHULN, Dept Coracao & Vasos, Serv Cardiol, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal
[5] Univ Lisbon, Fac Med, Lab Clin Pharmacol & Therapeut, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal
[6] Univ Lisbon, Fac Med, Ctr Estudos Med Baseada Evidencia CEMBE, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal
关键词
Atrial fibrillation; Screening; Network meta-analysis; Systematic review; FOLLOW-UP; GENERAL-PRACTICE; RISK-FACTORS; DIAGNOSIS; CARE; MORTALITY; HEALTH; TRENDS; ASSOCIATION; PREVALENCE;
D O I
10.1007/s00392-022-02117-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:705 / 715
页数:11
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