Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model
Year: 2021
Type: article
Abstract: Background Atrial fibrillation (AF) screening is endorsed by certain guidelines for individuals aged ≥65 years. Yet many AF screening strategies exist, including the use of wrist-worn wearable devices, and their comparative effectiveness is not well-understood. Methods and Results We developed a decision-analytic model simulating 50 million individuals with an age, sex, and comorbidity profile matching the United States population aged ≥65 years (ie, with a guideline-based AF screening indication). We modeled no screening, in addition to 45 distinct AF screening strategies (comprising different modalities and screening intervals), each initiated at a clinical encounter. The primary effectiveness measure was quality-adjusted life-years, with incident stroke and major bleeding as secondary measures. We defined continuous or nearly continuous modalities as those capable of monitoring beyond a single time-point (eg, patch monitor), and discrete modalities as those capable of only instantaneous AF detection (eg, 12-lead ECG). In total, 10 AF screening strategies were effective compared with no screening (300-1500 quality-adjusted life-years gained/100 000 individuals screened). Nine (90%) effective strategies involved use of a continuous or nearly continuous modality such as patch monitor or wrist-worn wearable device, whereas 1 (10%) relied on discrete modalities alone. Effective strategies reduced stroke incidence (number needed to screen to prevent a stroke: 3087-4445) but increased major bleeding (number needed to screen to cause a major bleed: 1815-4049) and intracranial hemorrhage (number needed to screen to cause intracranial hemorrhage: 7693-16 950). The test specificity was a highly influential model parameter on screening effectiveness. Conclusions When modeled from a clinician-directed perspective, the comparative effectiveness of population-based AF screening varies substantially upon the specific strategy used. Future screening interventions and guidelines should consider the relative effectiveness of specific AF screening strategies.
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,025
Awards: Automated detection and prediction of atrial fibrillation during sepsis, AFGen Consortium: Atrial Fibrillation Genomics to Functional Analyses, Identifying primary care patients at increased risk of atrial fibrillation for screening interventions, Optimizing Atrial Fibrillation Management in CKD, Detecting bleeding events using EHRs for prediction in Afib, Community Surveillance of Coronary Heart Disease, Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF), Smartwatch Monitoring for Atrial Fibrillation After Stroke, Mentoring in Arrhythmia Research, RURAL: Risk Underlying Rural Areas Longitudinal Cohort Study, IDENTIFICATION OF COMMON GENETIC VARIANTS FOR ATRIAL FIBRILLATION AND PR INTERVAL, Integrated, Multidisciplinary Training in Cardiovascular Research, Genomics of Cardiac Arrhythmias
OpenAlex ID: W3198148828