Abstract Atrial fibrillation (AF) is the most common cardiac arrhythmia and prevalence is predicted to double over the next 30 years due to changing demographics and the rise in prevalence of risk factors such as hypertension and diabetes. Atrial fibrillation is associated with a five-fold increased stroke risk, but anticoagulation in eligible patients can reduce this risk by around 65%. Many people with AF currently go undetected and therefore untreated, either because they are asymptomatic or because they have paroxysmal AF. Screening has been suggested as one approach to increase AF detection rates and reduce the incidence of ischaemic stroke by earlier initiation of anticoagulation therapy. However, international taskforces currently recommend against screening, citing the cost implications and uncertainty over the benefits of a systematic screening programme compared to usual care. A number of large randomized controlled trials have commenced to determine the cost-effectiveness and clinical benefit of screening using a range of devices and across different populations. The recent AppleWatch study demonstrates how advances in technology are providing the public with self-screening devices that are increasingly affordable and accessible. Health care professionals should be aware of the implications of these emerging data for diagnostic pathways and treatment. This review provides an overview of the gaps in the current evidence and a summary of the arguments for and against screening.

中文翻译：

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房颤筛查：寻找证据


摘要 心房颤动 (AF) 是最常见的心律失常，由于人口结构的变化以及高血压和糖尿病等危险因素患病率的上升，预计未来 30 年其患病率将翻一番。心房颤动与中风风险增加五倍相关，但符合条件的患者进行抗凝治疗可以将这种风险降低约 65%。目前，许多房颤患者没有被发现，因此也没有得到治疗，要么是因为他们没有症状，要么是因为他们患有阵发性房颤。筛查被认为是通过早期开始抗凝治疗来提高房颤检出率和降低缺血性中风发病率的一种方法。然而，国际工作组目前建议不要进行筛查，理由是与常规护理相比，系统筛查计划的成本影响和益处的不确定性。许多大型随机对照试验已开始确定使用一系列设备和针对不同人群进行筛查的成本效益和临床益处。最近的 AppleWatch 研究表明，技术进步如何为公众提供越来越便宜且易于使用的自我筛查设备。卫生保健专业人员应该意识到这些新数据对诊断途径和治疗的影响。本综述概述了当前证据的差距，并总结了支持和反对筛查的论点。