Systematic Screening for Atrial Fibrillation in the Community: Evidence and Obstacles

With an ageing population globally, the burden of atrial fibrillation (AF) and its consequent complication of stroke and risk of mortality will continue to increase. Although opportunistic screening for AF by pulse check or ECG rhythm strip for people > 65 years of age is currently recommended, data are now emerging that demonstrate the possible benefits of systematic community screening. Such screening is capable of identifying previously undiagnosed AF in 0.5-3.0 % of all those screened. The effectiveness of screening programmes will be markedly weakened by the lack of a structured downstream management pathway, making it a mandatory component in any AF screening programme for the general population. Different tools, especially smartphone-based devices, have made AF screening in the community more feasible. However, the sensitivities and positive predictive values of the current versions of automated diagnostic algorithms for AF have to be improved further to increase the cost-efficiency of screening programmes.