Symptoms and quality of life in individuals with screen-detected atrial fibrillation: insights from the NORSCREEN trial

Background Screening for atrial fibrillation (AF) is based on the premise that the arrhythmia is often asymptomatic. Yet little is known about unrecognized symptoms or quality of life (QoL) in individuals prior to the diagnosis of screen-detected AF. Data on symptomatic burden in large-scale screening populations remain scarce, leaving it unclear whether "silent" AF is truly silent or merely undiagnosed. Purpose To assess AF-related symptoms and QoL among individuals with screen-detected AF compared with those without AF in a large nationwide screening cohort. Methods The NORSCREEN trial enrolled individuals aged ≥65 years with ≥1 additional stroke risk factor (CHA2DS2-VA ≥2) and no prior history of AF. Participants underwent 7 days of continuous single-lead ECG monitoring and a standardised questionnaire assessing symptoms and QoL using the RAND 36-Item Health Survey. We compared these baseline measures between participants with screen-detected AF and those who remained in sinus rhythm. Results Of 50,549 enrolled participants, 25,265 were randomized to ECG screening, and 19,723 completed the screening procedure. Possible AF-related symptoms were common in both participants with and without screen-detected AF (Figure 1). Notably, 62% of the participants with screen-detected AF reported neither tachycardia nor palpitations. No significant differences in RAND-36 QoL scores were observed between participants with and without screen-detected AF (Figure 2). Conclusions In this large-scale nationwide screening trial, the overall symptom burden was comparable between participants with and without screen-detected AF. Although tachycardia and palpitations were slightly more common among participants with screen-detected AF, most did not report these hallmark symptoms. Screen-detected AF was not associated with reduced QoL. These findings confirm that screening primarily detects asymptomatic AF with preserved QoL, emphasising the "silent" nature of early-stage AF.Figure 1Figure 2