Age-dependent yield of screening for undetected atrial fibrillation in stroke patients: the Find-AF study Screening for asymptomatic atrial fibrillation while monitoring the blood pressure at home: trial of regular versus irregular pulse for prevention of stroke (TRIPPS 2.0). Is screening for AF worthwhile? Stroke risk in a screened population from the SAFE study. A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study. Fecal immunochemical test accuracy in average-risk colorectal cancer screening. A randomised controlled trial and cost effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in the over 65s: (SAFE) [ISRCTN19633732] Screening for atrial fibrillation in the community: a multicenter validation trial. Screening for atrial fibrillation in general practice: a national, cross-sectional study of an innovative technology. The external validity of published randomized controlled trials in primary care Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study Major progress in anticoagulant uptake for atrial fibrillation at last: does it translate into stroke prevention? Atrial fibrillation and risk of dementia: a prospective cohort study.
Diagnosis of paroxysmal atrial fibrillation ( AF ) in stroke patients is challenging , but highly clinical ly relevant . The percentage of stroke patients with permanent AF  increases with age , but limited data are available for the age-dependent yield of paroxysmal AF by Holter monitoring . Patients with acute cerebral ischemia were included into the prospect i ve observational Find-AF study . Patients free from AF at presentation received 7 day Holter monitoring .  We calculated the percentage of otherwise undetected paroxysmal AF and the number needed to screen for age groups under 60 years , and in 5 year clusters from the age of 60 up to 85 and older . 272 patients were included , 43 ( 15.8 % ) had AF at admission , 33 patients with paroxysmal AF were identified by 7 day Holter ( n = 29 ) or medical history ( n = 4).The yield of 7 day Holter ECG  clearly increased with older age ( p = 0.004 ) : < 60 years : 5 % , 60–64 years : 5 % , 65–69 years : 7 % , 70–74 years : 11 % , 75–79 years : 13 % , 80–84 years : 25 % , ≥85 years : 39 % . The number needed to screen ( NNS ) to find one patient with paroxysmal AF decreased with age : ≤60 years : 18 , 60–64 years : 20 , 65–69 years : 14 , 70–74 years : 9 , 75–79 years : 8 , 80–84 years : 4 , ≥85 years : 3 , respectively . In patients < 65 years , all AF cases were detected by Holter ECG . The percentage of paroxysmal AF in stroke patients increases with age . The  7 day Holter ECG  is most efficient in elderly patients Asymptomatic atrial fibrillation ( AF ) is a common cause of strokes . Physician screening for AF has been recommended . Home screening for AF may increase the likelihood of detecting asymptomatic AF in patients at risk for stroke because of AF . The aim of this study was to assess the feasibility and accuracy of screening for AF when taking home blood pressure ( BP ) measurements using an automatic AF-detecting BP monitor .  Subjects aged > 64 years or those with hypertension , diabetes , congestive heart failure , or previous stroke were enrolled by their primary physicians and given the AF-BP monitor and an electrocardiographic event monitor to use at home for 30 days . The AF-BP monitor reading was compared with the electrocardiographic reading to calculate the sensitivity and specificity of the device for detecting AF . A total of 160 subjects were enrolled , with 10 withdrawing , 1 excluded , and 10 with no AF-BP monitor logs or electrocardiographic recordings . Of the 139 subjects included , 14 had known AF . There was a total of 3,316 days with AF-BP monitor readings and electrocardiographic readings . On the basis of the initial daily AF-BP monitor readings , the AF-BP monitor demonstrated sensitivity of 99.2 % and specificity of 92.9 % for detecting AF . Two subjects with no histories of AF had AF-BP monitor readings of AF that were confirmed by the electrocardiographic monitor . One of these subjects was started on warfarin . In conclusion , home screening for asymptomatic AF while taking BP measurements can be performed accurately . This can be used to detect new AF , allowing treatment with anticoagulation to reduce the future risk for stroke INTRODUCTION Atrial fibrillation ( AF ) is an important independent risk factor for stroke and oral anticoagulation therapy provides a highly effective treatment to reduce this risk . Active screening strategies improve detection of AF in comparison with routine care ; however , whether screen-detected patients have stroke risk profiles favouring anticoagulation is unclear . Using data derived from the screening for AF in the elderly ( SAFE ) study , the aim of this article was to determine if patients with AF detected via active screening  have stroke risk profiles that warrant prophylactic anticoagulation . METHODS Secondary analysis of data derived from 25 general practice s within which cohorts of 200 patients were r and omly allocated to opportunistic [ pulse and electrocardiogram ( ECG ) ] or systematic screening ( postal invitation for ECG ) .  Stroke risk assessment was undertaken using baseline data extracted from medical records and CHADS2 criteria . CHADS2 scores were compared between the screening groups . RESULTS One hundred and forty-nine new cases of AF were detected , 75 via opportunistic screening and 74 via systematic screening . CHADS2 scores were ≥1 in 83 % [ 95 % confidence interval ( CI ) 72.6 - 89.6 ] of patients detected via opportunistic screening and 78 % ( 95 % CI 67.7 - 86.2 ) detected via systematic screening . There were no significant differences in stroke risk profiles of patients detected via opportunistic and systematic screenings . CONCLUSION Stroke risk profiles of patients detected via opportunistic and systematic screenings were similar . Data derived from the SAFE study suggest that active screening for AF in patients aged ≥65 years in primary care is a useful screening programme with 78 - 83 % of patients identified eligible for anticoagulation treatment according to the CHADS2 criteria OBJECTIVES To determine the most cost-effective method of screening for  atrial fibrillation ( AF ) in the population aged 65 years and over , as well as its prevalence and incidence in this age group . Also to evaluate the relative cost-effectiveness of different methods of recording and interpreting the electrocardiogram ( ECG ) within a screening programme . DESIGN Multicentred r and omised controlled trial . Purpose fully selected general practice s were r and omly allocated to 25 intervention practice s and 25 control practice s. SETTING Fifty primary care centres across the West Midl and s , UK . PARTICIPANTS Patients aged 65 years and over . INTERVENTIONS GPs and practice nurses in the intervention practice s received education on the importance of AF detection and ECG interpretation . Patients in the intervention practice s were r and omly allocated to systematic ( n = 5000 ) or opportunistic screening ( n = 5000 ) . Prospect i ve identification of pre-existing risk factors for AF within the screened population enabled comparison between targeted screening of people at higher risk of AF and total population screening . MAIN OUTCOME MEASURES AF detection rates in systematic ally screened and opportunistically screened population s in the intervention practice s were compared with AF detection rate in 5000 patients in the control practice s. The screening period was 12 months . RESULTS Baseline prevalence of AF was 7.2 % , with a higher prevalence in males ( 7.8 % ) and patients aged 75 years and over ( 10.3 % ) . The control population demonstrated higher baseline prevalence ( 7.9 % ) than either the systematic ( 6.9 % ) or opportunistic ( 6.9 % ) intervention population . In the control population 47 new cases were detected ( incidence 1.04 % per year ) . In the opportunistic arm 243 patients without a baseline diagnosis of AF were found to have an irregular pulse , with 177 having an ECG , yielding 31 new cases ( incidence 0.69 % per year ) . A further 44 cases were detected outside the screening programme ( overall incidence 1.64 % per year ) . In the systematic arm 2357 patients had an ECG yielding 52 new cases ( incidence 1.1 % per year ) . Of these , 31 were detected by targeted screening and a further 21 by total population screening . A further 22 cases were detected outside the screening programme ( overall incidence 1.62 % per year ) . In terms of ECG interpretation , computerised decision support software ( CDSS ) gave a sensitivity of 87.3 % , a specificity of 99.1 % and a positive predictive value ( PPV ) of 89.5 % compared with the gold st and ard ( cardiologist reporting ) . GPs and practice nurses performed less well . The only difference in performance between intervention population s and controls was that practice nurses from the control arm performed less well than with intervention practice nurses on interpretation of limb-lead ( PPV 38.8 % versus 20.8 % ) and single-lead ( PPV 37.7 % versus 24.0 % ) ECGs . The within-trial economic evaluation results showed the lowest incremental cost to be for the opportunistic arm , with an incremental cost-effectiveness ratio of 337 pounds Sterling for each additional case detected compared to the control arm . Opportunistic screening dominated both more intensive screening strategies . Model-based analyses showed small differences in cost and quality -adjusted life-years for different methods and intensities of screening , but annual opportunistic screening result ed in the lowest number of ischaemic strokes and greatest proportion of cases of AF diagnosed . Probabilistic sensitivity results indicated that there was a probability of approximately 60 % that screening from the age of 65 years was cost-effective in both men and women . CONCLUSIONS The results of the study indicated that in terms of a screening programme for atrial fibrillation in patients 65 and over , the only strategy that improved on routine practice was opportunistic screening , model-based analyses indicated that there was a probability of approximately 60 % of annual opportunistic screening being cost effective . It is suggested that the following topics are worthy of further investigation : the effect of the implementation of a screening programme for AF on the uptake and maintenance of anticoagulation in patients aged 65 years and over ; an evaluation of the role of CDSS in the diagnosis of cardiac arrythmias ; the best method for routinely detecting paroxysmal AF ; ways of improving healthcare professionals ' performance in ECG interpretation ; development of a robust economic model to incorporate data on new therapeutic agents for use as thromboprophylactic agents for patients with AF , and an evaluation of the relative risk of stroke for patients with incident as opposed to prevalent AF AIM To assess the fecal immunochemical test ( FIT ) accuracy for colorectal cancer ( CRC ) and advanced neoplasia ( AN ) detection in CRC screening . METHODS We performed a multicentric , prospect i ve , double blind study of diagnostic tests on asymptomatic average-risk individuals su bmi tted to screening colonoscopy . Two stool sample s were collected and the fecal hemoglobin concentration was determined in the first sample ( FIT1 ) and the highest level of both sample s ( FITmax ) using the OC-sensor ™ . Areas under the curve ( AUC ) for CRC and AN were calculated . The best FIT1 and FITmax cut-off values for CRC were determined . At this threshold , number needed to scope ( NNS ) to detect a CRC and an AN and the cost per lesion detected were calculated . RESULTS About 779 individuals were included . An AN was found in 97 ( 12.5 % ) individuals : a CRC in 5 ( 0.6 % ) and an advanced adenoma ( ≥ 10 mm , villous histology or high grade dysplasia ) in 92 ( 11.9 % ) subjects . For CRC diagnosis , FIT1 AUC was 0.96 ( 95%CI : 0.95 - 0.98 ) and FITmax AUC was 0.95 ( 95%CI : 0.93 - 0.97 ) . For AN , FIT1 and FITmax AUC were similar ( 0.72 , 95%CI : 0.66 - 0.78 vs 0.73 , 95%CI : 0.68 - 0.79 , respectively , P = 0.34 ) . Depending on the number of determinations and the positivity threshold cut-off used sensitivity for AN detection ranged between 28 % and 42 % and specificity between 91 % and 97 % . At the best cut-off point for CRC detection ( 115 ng/mL ) , the NNS to detect a CRC were 10.2 and 15.8 ; and the cost per CRC was 1814 € and 2985 € on FIT1 and FITmax strategies respectively . At this threshold the sensitivity , NNS and cost per AN detected were 30 % , 1.76 , and 306 € , in FIT1 strategy , and 36 % , 2.26 € and 426 € , in FITmax strategy , respectively . CONCLUSION Performing two tests does not improve diagnostic accuracy , but increases cost and NNS to detect a lesion Background Atrial fibrillation ( AF ) has been recognised as an important independent risk factor for thromboembolic disease , particularly stroke for which it provides a five-fold increase in risk . This study aim ed to determine the baseline prevalence and the incidence of AF based on a variety of screening strategies and in doing so to evaluate the incremental cost-effectiveness of different screening strategies , including targeted or whole population screening , compared with routine clinical practice , for detection of AF in people aged 65 and over . The value of clinical assessment and echocardiography as additional methods of risk stratification for thromboembolic disease in patients with AF were also evaluated . Methods The study design was a multi-centre r and omised controlled trial with a study population of patients aged 65 and over from 50 General Practice s in the West Midl and s. These purpose fully selected general practice s were r and omly allocated to 25 intervention practice s and 25 control practice s. GPs and practice nurses within the intervention practice s received education on the importance of AF detection and ECG interpretation . Patients in the intervention practice s were r and omly allocated to systematic ( n = 5000 ) or opportunistic screening ( n = 5000 ) . Prospect i ve identification of pre-existing risk factors for AF within the screened population enabled comparison between high risk targeted screening and total population screening . AF detection rates in systematic ally screened and opportunistically screened population s in the intervention practice s were compared to AF detection rate in 5,000 patients in the control practice BACKGROUND Atrial fibrillation ( AF ) is an important public health problem . This arrhythmia is common and associated with a high risk of stroke . Further , appropriate interventions in AF can reduce the risk of stroke by approximately 68 % . Population studies show that a large group of patients have intermittent or chronic AF that remains unrecognized . If a simple screening test for this arrhythmia could be developed and vali date d , application of the technique across population s might identify AF patients for early treatment , potentially reducing the incidence of stroke . In this study , we sought to determine whether individuals taken from the general community could be taught to find and classify the pulse of another as very irregular , implying AF , or regular , implying normal sinus rhythm ( NSR ) . The aim was to establish that pulse examination for potential AF could be performed by individuals with sufficient sensitivity and specificity to be effectively used as a screening procedure for this medically important arrhythmia . METHODS We enrolled 178 subjects selected from the general community from four centers . Subjects received st and ardized education on the medical importance of AF and its signature , a very irregular pulse . A technique for palpating and characterizing the rhythm of the radial pulse was also taught . Without further coaching , subjects were then asked to find their pulse and then to find and classify the pulse of two models r and omly presented who may or may not have had AF . RESULTS Of the 178 subjects tested , 92 % were able to find their own pulse ; 17 ( 9.6 % ) were unable to find the pulse of one or both patient models and were , therefore , excluded from the study . Of the remaining 161 subjects , 76 % ( 122 of 161 ) correctly identified the pulse in an AF model , and 86 % ( 139 of 161 ) correctly identified the pulse in an NSR model . Results did not statistically differ as a function of age , educational status , or location . DISCUSSION This multicenter trial established that given minimal st and ardized instructions , subjects from the general community can reliably and consistently find both their pulse as well as the pulse of another and to differentiate a regular pulse from a very irregular pulse . If similar educational programs were widely applied across large population s , periodic screening for AF might lead to earlier diagnosis and appropriate treatment for patients who have this major risk factor for stroke . These screening programs should be focused on the population over the age of 55 where the risk of stroke in AF increases with each decade BACKGROUND To test the use of three lead monitoring as a screening tool for  atrial fibrillation ( AF )  in general practice . AF is responsible for up to a quarter of all strokes and is often asymptomatic until a stroke occurs . METHODS 26 r and omly selected general practice s identified 80 r and omly selected patients aged 70 or older from their data base and excluded those known to have AF , those with clinical issues or who had not attended for three years . Up to 40 eligible patients / practice were invited to attend for screening . A 2min three-lead ECG was recorded and collected central ly for expert cardiology assessment . Risk factor data was gathered . OUTCOMES ( i ) point prevalence of AF , ( ii ) proportion of ECG tracings which were adequate for interpretation , ( iii ) uptake rate by patients and ( iv ) acceptability of the screening process to patients and staff ( reported separately ) . RESULTS Of 1447 current patients , 1003 were eligible for inclusion , 639 ( 64 % ) agreed to take part in screening and 566 ( 56 % ) completed screening . The point prevalence rate for AF was 10.3%-2.1 % new cases ( 12 of 566 who were screened ) and 9.5 % existing cases ( 137 of 1447 eligible patients ) . Only four of 570 ( 0.7 % ) screening visits did not record a usable ECG and 11 ( 2.6 % ) three lead ECGs required a clarifying 12 lead ECG . CONCLUSIONS Three lead screening for AF is feasible , effective and offers an alternative to pulse taking or 12 lead ECGs . The availability of this technology may facilitate more effective screening , leading to reduced stroke incidence Background A criticism of R and omized Controlled Trials ( RCTs ) in primary care is that they lack external validity , participants being unrepresentative of the wider population . Our aim was to determine whether published primary care-based RCTs report information about how the study sample is assembled , and whether this is associated with RCT characteristics . Methods We review ed  RCTs published in four primary care journals in the years 2001–2004 . Main outcomes were : ( 1 ) eligibility fraction ( proportion eligible of those screened ) , ( 2 ) enrolment fraction ( proportion r and omised of those eligible ) , ( 3 ) recruitment fraction ( proportion of potential participants actually r and omised ) , and ( 4 ) number of patients needed to be screened ( NNS ) in order to r and omize one participant . Results A total of 148 RCTs were review ed . One hundred and three trials ( 70 % ) reported the number of individuals assessed by investigators for eligibility , 119 ( 80 % ) reported the number eligible for participation , and all reported the actual number recruited . The median eligibility fraction was 83 % ( IQR 40 % to 100 % ) , and the median enrolment fraction was 74 % ( IQR 49 % to 92 % ) . The median NNS was 2.43 , with some trials reportedly recruiting every patient or practice screened for eligibility , and one trial screening 484 for each patient recruited . We found no association between NNS and journal , trial size , multi- or single-centre , funding source or type of intervention . There may be associations between provision of sufficient recruitment data for the calculation of NNS and funding source and type of intervention . Conclusion RCTs reporting recruitment data in primary care suggest that once screened for eligibility and found to match inclusion criteria patients are likely to be r and omized . This finding needs to be treated with caution as it may represent inadequate identification or reporting of the eligible population . A substantial minority of RCTs did not provide sufficient information about the patient recruitment process Background : Asymptomatic atrial fibrillation ( AF ) is increasingly common in the aging population and implicated in many ischemic strokes . Earlier identification of AF with appropriate anticoagulation may decrease stroke morbidity and mortality . Methods : We conducted a r and omized controlled trial of AF screening using an AliveCor Kardia monitor attached to a WiFi-enabled iPod to obtain ECGs ( iECGs ) in ambulatory patients . Patients ≥65 years of age with a CHADS-VASc score ≥2 free from AF were r and omized to the iECG arm or routine care ( RC ) . iECG participants acquired iECGs twice weekly over 12 months ( plus additional iECGs if symptomatic ) onto a secure study server with overread by an automated AF detection algorithm and by a cardiac physiologist and /or consultant cardiologist . Time to diagnosis of AF was the primary outcome measure . The overall cost of the devices , ECG interpretation , and patient management were captured and used to generate the cost per AF diagnosis in iECG patients . Clinical events and patient attitudes/experience were also evaluated . Results : We studied 1001 patients ( 500 iECG , 501 RC ) who were 72.6±5.4 years of age ; 534 were female . Mean CHADS-VASc score was 3.0 ( heart failure , 1.4 % ; hypertension , 54 % ; diabetes mellitus , 30 % ; prior stroke/transient ischemic attack , 6.5 % ; arterial disease , 15.9 % ; all CHADS-VASc risk factors were evenly distributed between groups ) . Nineteen patients in the iECG group were diagnosed with AF over the 12-month study period versus 5 in the RC arm ( hazard ratio , 3.9 ; 95 % confidence interval=1.4–10.4 ; P=0.007 ) at a cost per AF diagnosis of $ 10 780 ( £ 8255 ) . There was a similar number of stroke/transient ischemic attack/systemic embolic events ( 6 versus 10 , iECG versus RC ; hazard ratio=0.61 ; 95 % confidence interval=0.22–1.69 ; P=0.34 ) . The majority of iECG patients were satisfied with the device , finding it easy to use without restricting activities or causing anxiety . Conclusions : Screening with twice-weekly single-lead iECG with remote interpretation in ambulatory patients ≥65 years of age at increased risk of stroke is significantly more likely to identify incident AF than RC over a 12-month period . This approach is also highly acceptable to this group of patients , supporting further evaluation in an appropriately powered , event-driven clinical trial . Clinical Trial Registration : URL : https://www.is rct n.com . Unique identifier : IS RCT N10709813 A number of r and omized controlled trials in atrial fibrillation ( AF ) conducted in the last century showed that vitamin K antagonists , ( VKAs ) , principally warfarin , were remarkably effective in stroke prevention , reducing stroke by 64 % and all-cause mortality by 26 % , figures rarely matched in treatments of other diseases . With the introduction of the non-VKA anticoagulants ( NOACs ) in the last 8 years , stroke reduction in the r and omized trials was similar to VKAs , but with less intracranial haemorrhage and a further 1 % absolute risk reduction in total mortality ; results confirmed in many ‘ real-life ’ studies using administrative or registry data . Many guidelines , including the first joint AHA/ACC/ESC guideline in 2001 , recommended oral anticoagulant ( OAC ) therapy for those with AF at elevated risk of stroke , as have subsequent joint and ESC guidelines and up date s in 2006 , 2010 , 2012 , and 2016 . But OAC uptake has been less than ideal for some time , hovering in the UK at 50 % of those for whom OAC was guideline recommended , in the 10 years from 2001 to 2011 . The data from the Swedish RIKS registry of > 94 000 strokes help identify the two major gaps in prevention of AF-related strokes , which represent 33 % of all ischaemic strokes ( Take home figure ) . In 9 % of all strokes , AF was not known prior to stroke : prevention would require screening to detect and treat unknown AF . In another 20 % , AF was known but patients were either on no antithrombotic therapy ( 8 % ) or on antiplatelet therapy alone ( 12 % ) , which is largely ineffective for AF thrombo-prophylaxis . Thus , up to 20 % of ischaemic strokes might be prevented if the evidence – practice gap of OAC prescription was eliminated . It is therefore very pleasing to see in this issue of the European Heart Journal that in the UK ,  OAC use in patients with elevated stroke risk  has increased from < 50 % to almost 80 % in the 10 years from 2006 to 2016 , mostly in the latter 5 years , while  antiplatelet therapy  has reduced from 43 % to 16 % . This is a great success story , observed to some degree in many countries , but by no means uniformly , even within the same country . Trying to pinpoint the reason for this improvement is not easy . Success has many fathers , while failure is an orphan . Cowan and colleagues postulate that successive ESC and NICE guidelines , quality improvement incentivization programmes such as GRASP and QOF , or licensing and marketing of NOACs , accentuating their ease of use , could all have played a role , but it is difficult to determine which is the major one . ESC guidelines and their up date s were recommending OAC in 2001 , 2006 , and 2010 , and the GRASP quality initiative from 2009 , with little change in OAC uptake , while QOF did not commence until 2012 . It is instructive to look at our own UK data using a higher resolution temporal trend of OAC initiation within 90 days of incident AF ( Figure 1 ) . The graph plots total OAC initiations for patients with CHA2DS2-VASc > _ 2 . A rise in VKA OAC prescription was observed from early 2011 , when limited marketing preceded the availability of NOAC drugs , followed by an accentuated increase due to NOAC prescription accompanied by a plateau in VKA prescription . It is quite likely that at this time point , the availability and marketing of NOACs played a dominant role , with this influence increasing as additional NOACs became available . The final increase from 2013 to 2106 is probably a combination of all three factors : an effective national QOF quality framework , gradual percolation of guidelines and up date s , and continued marketing of NOACs . Ensuring that a high proportion of patients with AF are taking effective doses of OAC rather than aspirin requires first that OAC is offered by the physician and accepted by the patient , secondly that patients are adherent to taking the drugs as prescribed , achieving > 70 % time in the therapeutic international normalized ratio ( INR ) range for VKAs , and finally , that patients persist with taking  OAC therapy long-term . There is a high non-persistence rate for OAC in the first 2 years after initiation , significantly greater for VKAs than OBJECTIVES To determine whether  atrial fibrillation ( AF )  is associated with risk of incident dementia or Alzheimer 's disease ( AD ) , beyond its effect on stroke . DESIGN Prospect i ve cohort study . SETTING An integrated healthcare delivery system . PARTICIPANTS A population -based sample of 3,045 community-dwelling adults aged 65 and older without dementia or clinical stroke followed from 1994 to 2008 . MEASUREMENTS AF was identified from health plan electronic data using International Classification of Diseases , Ninth Revision , codes from inpatient and outpatient encounters . Covariates came from self-report , study measures , and health plan data . Participants were screened every 2 years using the Cognitive Abilities Screening Instrument ( range 0 - 100 ) , with detailed neuropsychological and clinical assessment of those scoring less than 86 . A multidisciplinary consensus committee determined diagnoses of all-cause dementia and possible or probable AD using st and ard research criteria . RESULTS  AF  was present in 132 ( 4.3 % ) participants at baseline and was diagnosed in 370 ( 12.2 % ) more over a mean of 6.8 years of follow-up ; 572 participants ( 18.8 % ) developed dementia ( 449 with AD ) . The adjusted hazard ratio associated with AF was 1.38 ( 95 % confidence interval (CI)=1.10 - 1.73 ) for all-cause dementia and 1.50 ( 95 % CI=1.16 - 1.94 ) for possible or probable AD . Results were similar for participants with and without clinical ly recognized stroke during follow-up and in sensitivity analyses examining only probable AD . CONCLUSION AF is associated with higher risk of developing AD and dementia . Future studies should examine whether specific treatments , including optimal anticoagulation , can decrease this risk
Pooled yield of screening was greater in males across all age strata .
Neither the choice of screening methodology or device , the geographical region , nor the screening setting influenced the detection rate of AF .
The main limitation of this study is there are insufficient data on sociodemographic variables of the population s and possible ascertainment biases to explain the variance in the sample s. CONCLUSIONS People with screen-detected AF are at elevated calculated stroke risk : above age 65 , the majority have a Class-1 OAC recommendation for stroke prevention , and > 70 % have ≥1 additional stroke risk factor other than age/sex .
BACKGROUND The precise age distribution and calculated stroke risk of screen-detected atrial fibrillation ( AF ) is not known .
Therefore , it is not possible to determine the number needed to screen ( NNS ) to identify one treatable new AF case ( NNS-Rx ) ( i.e. , Class-1 oral anticoagulation [ OAC ] treatment recommendation ) in each age stratum .
If the NNS-Rx is known for each age stratum , precise cost-effectiveness and sensitivity simulations can be performed based on the age distribution of the population /region to be screened .
Such calculations are required by national authorities and organisations responsible for health system budgets to determine the best age cutoffs for screening programs and decide whether programs of screening should be funded .
Therefore , we aim ed to determine the exact yield and calculated stroke-risk profile of screen-detected AF and NNS-Rx in 5-year age strata .