Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model
Why the study?
Although AF screening is endorsed by certain guidelines for individuals aged ≥65 years, many screening strategies exist and their comparative effectiveness is not well-understood.
Do specific atrial fibrillation screening strategies improve quality-adjusted life-years in individuals aged ≥65 years compared to no screening?
Population
50 million simulated individuals matching the United States population aged ≥65 years
Comparison
45 distinct AF screening strategies vs no screening
Design
Decision-analytic model
Authors
Discussion
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Implication
May support continuous AF screening for QALY gains in adults ≥65; leaves open prospective trials to confirm net benefit.
Key Points
- To evaluate the comparative clinical effectiveness of 45 contemporary population-based atrial fibrillation screening strategies in individuals aged 65 years and older.
- Developed a decision-analytic model simulating 50 million individuals matching the age, sex, and comorbidity profile of the United States population aged ≥65 years.
- Evaluated no screening against 45 distinct clinician-initiated screening strategies combining discrete modalities (e.g., 12-lead ECG) or continuous modalities (e.g., patch monitors, smartwatches) across varied intervals.
- Measured primary health outcomes using quality-adjusted life-years, with secondary endpoints of incident stroke, major bleeding, and intracranial hemorrhage.
- Ten screening strategies improved outcomes over no screening (300–1,500 quality-adjusted life-years gained per 100,000 screened), with 90% (9 of 10) requiring continuous or nearly continuous monitoring modalities.
- Effective strategies reduced incident stroke (number needed to screen: 3,087–4,445) but increased major bleeding (number needed to screen: 1,815–4,049) and intracranial hemorrhage (number needed to screen: 7,693–16,950).
- Model sensitivity analyses revealed that test specificity was a highly influential parameter determining the overall clinical effectiveness of atrial fibrillation screening.
Structured PICO
Do specific atrial fibrillation screening strategies improve quality-adjusted life-years in individuals aged ≥65 years compared to no screening?
P
Population
Simulated cohort of 50 million individuals with an age, sex, and comorbidity profile matching the United States population aged ≥65 years with a guideline-based atrial fibrillation screening indication
I
Intervention
45 distinct atrial fibrillation screening strategies comprising different modalities (continuous/nearly continuous such as patch monitors or wrist-worn wearable devices, and discrete such as 12-lead ECG) and screening intervals, initiated at a clinical encounter
C
Comparator
No screening
O
Outcome
Quality-adjusted life-years (QALYs)
Continuous or nearly continuous atrial fibrillation screening modalities, such as wearables or patch monitors, are more effective than discrete modalities at improving quality-adjusted life-years in older adults, though they increase bleeding risk.
Cite This Study
Khurshid et al. (2021) studied this question.