Key result
AF screening cuts thromboembolism risk ~7% vs no intervention without increasing major bleeding or mortality.
Why the study?
Recommendations on atrial fibrillation screening by scientific societies are inconsistent due to uncertainty regarding its clinical benefit.
Does atrial fibrillation screening reduce thromboembolism, major bleeding, and mortality compared to no intervention?
Meta-Analysis (n=74,145)
Does atrial fibrillation screening reduce thromboembolism, major bleeding, and mortality compared to no intervention?
Atrial fibrillation screening increases AF detection and oral anticoagulation initiation, leading to a modest reduction in thromboembolic events without increasing major bleeding risk.
Supports AF screening to reduce thromboembolism; reinforces outcome benefit without bleeding or mortality trade-off.
BACKGROUND: Recommendations on atrial fibrillation (AF) screening by various scientific societies are inconsistent due to uncertainty about its benefit. This study aimed to summarize data from randomized controlled trials (RCTs) on the impact of AF screening on thromboembolism, major bleeding, and mortality. METHODS AND RESULTS: We searched PubMed/MEDLINE and Embase to identify studies providing relevant data through 5 September 2024. Risk ratios (RRs) for each reported outcome of interest were pooled through a meta-analysis with random effects models. We included six RCTs reporting data from 74 145 individuals. AF screening was associated with higher AF detection compared with no intervention [RR 2.54, 95% confidence interval (CI): 1.57-4.11, P < 0.001], and more common initiation of oral anticoagulation (RR 2.19, 1.51-3.18, P < 0.001). Incident ischaemic stroke (RR 0.93, 0.87-1.00, P = 0.048) and thromboembolism including ischaemic stroke, transient ischaemic attack, or systemic embolism (0.93, 95% CI: 0.87-0.99, P = 0.026) were less frequent in individuals who underwent AF screening vs. controls. There was no difference for major bleeding, (RR 0.99, 95% CI: 0.93-1.06, P = 0.830), haemorrhagic stroke (RR 0.94, 95% CI: 0.80-1.11, P = 0.497) and all-cause mortality (RR 0.99, 95% CI: 0.95-1.02, P = 0.411). CONCLUSION: AF screening might be beneficial, especially in reducing thromboembolic events.
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Nyaga et al. (2025) conducted a meta-analysis in Atrial fibrillation (n=74,145). Atrial fibrillation screening vs. No intervention was evaluated on Thromboembolism including ischaemic stroke, transient ischaemic attack, or systemic embolism (RR 0.93, 95% CI 0.87-0.99, p=0.026). Atrial fibrillation screening reduced the risk of thromboembolism compared with no intervention (RR 0.93; 95% CI 0.87-0.99; P=0.026), without increasing major bleeding or all-cause mortality.
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