Today, I review, link to, and excerpt from The ESC’s 2024 Guidelines On Screening For Atrial Fibrillation. (2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): Developed by the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC), with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO) [Full-Text HTML] [Full-Text PDF])
All that follows is from the above resource.
- 10.1. Epidemiology of AF 3371
- 10.2. Screening tools for AF 3371
- 10.3. Screening strategies for AF 3373
- 10.3.1. Single timepoint screening ‘snapshot’ 3374
- 10.3.2. Prolonged screening 3374
- 10.4. Factors associated with incident AF 3375
- 10.5. Primary prevention of AF 3375
- 10.5.1. Hypertension 3376
- 10.5.2. Heart failure 3376
- 10.5.3. Type 2 diabetes mellitus 3376
- 10.5.4. Obesity 376
- 10.5.6. Physical activity 3376
- 10.5.7. Alcohol intake 3377
Figure 16Approaches to screening for AF.
AF, atrial fibrillation; AF-CARE, atrial fibrillation—[C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, [E] Evaluation and dynamic reassessment; CHA2DS2-VA, congestive heart failure, hypertension, age ≥75 years (2 points), diabetes mellitus, prior stroke/TIA/arterial thromboembolism (2 points), vascular disease, age 65–74 years; ECG, electrocardiogram. See Figure 15 for non-invasive ECG methods.
Invasive monitoring of heart rhythm in high-risk populations extended for several years has been shown to result in device-detected AF prevalence of around 30%, albeit most of whom have a low burden of AF.5,857,1130,1131 Pacemaker studies have shown that patients with a low burden of device-detected subclinical AF have a lower risk of ischaemic stroke.5,24,1131,1132 This has been confirmed in RCTs assessing DOAC use in patients with device-detected subclinical AF (see Section 6.1.1).5,281,282 The burden needed for device-detected subclinical AF to translate into stroke risk is not known, and further studies are clearly needed.1133,1134 Benefit and cost-effectiveness of screening are discussed in the Supplementary data online.
Recommendation Table 31
Recommendations for screening for AF (see also Evidence Table 31)
Table 16
Factors associated with incident AF
Demographic factors Age1149–1151 Male sex1149–1152 European ancestry1149,1150 Lower socioeconomic status1150 Lifestyle behaviours Smoking/tobacco use1149–1151 Alcohol intake1149,1150 Physical inactivity1149,1150 Vigorous exercise1153–1156 Competitive or athlete-level endurance sports1151,1157 Caffeine1158–1160 Comorbidities and risk factors Hypertension1149–1151 Heart failure178,1149–1151,1161 Valvular disease1149,1151,1162–1164 Coronary artery disease1149,1151,1161,1165 Peripheral arterial disease785 Congenital heart disease1149,1166 Heart rate, heart rate variability1167,1168 Total cholesterol1149,1150 Low-density lipoprotein cholesterol1150 High-density lipoprotein cholesterol1150 Triglycerides1150 Impaired glucose tolerance,1169–1172diabetes mellitus1149–1151,1169 Renal dysfunction/CKD1149–1151,1173,1174 Obesity1149–1151,1175,1176 Body mass index, weight1149–1151 Height1150 Sleep apnoea1149,1151,1177,1178 Chronic obstructive pulmonary disease1179 Subclinical atherosclerosis Coronary artery calcification1149,1151,1180 Carotid IMT and carotid plaque1149,1151,1181,1182 ECG abnormalities PR interval prolongation1149,1151,1183 Sick sinus syndrome1149,1184,1185 Wolff–Parkinson–White1149,1186 Genetic factors Family history of AF1149,1151,1187–1190 AF-susceptible loci identified by GWAS1149,1151,1191,1192 Short QT syndrome1149 Genetic cardiomyopathies990,1193 Biomarkers C-reactive protein1150,1151 Fibrinogen1150 Growth differentiation factor-151194 Natriuretic peptides (atrial and B-type)1195–1200 Cardiac troponins1199 Inflammatory biomarkers 1149,1151 Others Thyroid dysfunction912,1149–1151 Autoimmune diseases1150 Air pollution1149,1201 Sepsis1149,1202 Psychological factors 1203,1204 AF, atrial fibrillation; CKD, chronic kidney disease; GWAS, genome-wide association studies; HF, heart failure; IMT, intima-media thickness.
Recommendation Table 32
Recommendations for primary prevention of AF (see also Evidence Table 32
