AF-SCREEN Response to USPSTF
In December 2017, the US Preventive Services Task Force (USPSTF) released its draft recommendations and a large evidence review on ECG screening for AF, citing insufficient evidence to make a recommendation (“I grade”). To see this draft from the USPSTF, click here. Overall, the statement was rather negative, and contained some inaccuracies. The AF-SCREEN steering committee itself provided comments to the USPSTF, click here for the one-page summary and click here for the complete response.
White Paper published in Circulation
In May 2017, the AF-SCREEN International Collaboration White Paper was published in Circulation as a State of the Art article. A one-page summary is available for download here. The flow diagram is available for download here.
Screening for Atrial Fibrillation: A Report of the AF-SCREEN International Collaboration.
Freedman B, Camm J, Calkins H, Healey JS, Rosenqvist M, Wang J, Albert CM, Anderson CS, Antoniou S, Benjamin EJ, Boriani G, Brachmann J, Brandes A, Chao TF, Conen D, Engdahl J, Fauchier L, Fitzmaurice DA, Friberg L, Gersh BJ, Gladstone DJ, Glotzer TV, Gwynne K, Hankey GJ, Harbison J, Hillis GS, Hills MT, Kamel H, Kirchhof P, Kowey PR, Krieger D, Lee VWY, Levin LÅ, Lip GYH, Lobban T, Lowres N, Mairesse GH, Martinez C, Neubeck L, Orchard J, Piccini JP, Poppe K, Potpara TS, Puererfellner H, Rienstra M, Sandhu RK, Schnabel RB, Siu CW, Steinhubl S, Svendsen JH, Svennberg E, Themistoclakis S, Tieleman RG, Turakhia MP, Tveit A, Uittenbogaart SB, Van Gelder IC, Verma A, Wachter R, Yan BP.
Circulation. 2017 May 9;135(19):1851-1867. doi: 10.1161/CIRCULATIONAHA.116.026693. Review. PMID: 28483832
The link to this white paper is: http://circ.ahajournals.org/content/135/19/1851.full?ijkey=StzSPk8eljGaP2G&keytype=ref
A Delphi Process was used for the AF-SCREEN consensus meeting in August 2016 in Rome just prior to the ESC meeting. The document developed there forms the basis for the published White Paper.
The document content and structure were agreed by the steering committee (John Camm UK, Hugh Calkins USA, Ben Freedman Australia, Jeff Healey Canada, Mårten Rosenqvist Sweden, and Jiguang Wang China), and AF-SCREEN members, in late 2015. Individual sections were allocated to and written by 18 small groups of members with content expertise (co-authors), many of whom were the lead investigators of the seminal papers in that particular area. Each group was encouraged to produce one or more draft recommendations. A Delphi process involved the steering committee voting on which key questions should be selected for discussion and secret voting by those present at the AF-SCREEN consensus meeting. This meeting was held in August 2016, immediately before the ESC annual scientific meeting in Rome. Following voting at the meeting, those draft recommendations which received a large number of votes were workshopped over 2 days, and 7 selected for on-line secret voting by all members. The panel below shows the final wording of the key questions used in the on-line ballot, and the number of votes, with the percent agreement with the statement/key question. All seven received >85% agreement (Panel 1). These formed the basis of the key points used in the white paper. No formal recommendations are provided in the white paper.
AF-SCREEN Key Issues
- Screen-detected AF as found on single timepoint screening, or intermittent 30 second recordings over 2 weeks, is not a benign condition, and with additional stroke risk factors, carries sufficient risk of stroke to justify consideration of screening and therapy to prevent stroke. 105 votes, 98% agreed
- Single timepoint screening of people aged 65 or over in the clinic or community is recommended, based on yield of screening and cost-effectiveness. 104 votes, 93% agreed
- As a further step after single timepoint screening, two weeks of twice-daily intermittent handheld ECG recording should be considered for screening for AF in people aged 75 or over, or in younger age groups at high risk of AF or stroke. 104 votes, 86% agreed
- Long-term continuous rhythm monitoring using either external or implanted devices or extended intermittent patient-activated recordings is recommended for individuals with recent embolic stroke of undetermined source (ESUS). 104 votes, 92% agreed
- The setting for AF screening needs to be individualized according to country-specific and health care system-specific requirements and resources and must be linked to a pathway for appropriate diagnosis and management. This can be community-based or in primary care or specialist practices or clinics. 105 votes, 99% agreed
- Mass screening or opportunistic screening for AF can be accomplished by pulse palpation; oscillometric (blood pressure) or photoplethysmographic (smartphone camera) devices; and handheld ECG devices providing a rhythm strip. ECG confirmation is always required for diagnosis of AF. Handheld ECG devices have the advantage of providing a verifiable ECG trace and are preferred. 105 votes, 93% agreed
- Large randomized controlled studies using hard endpoints (including stroke/systemic embolism and death), of strategies for screening should be performed to strengthen evidence to inform national systematic screening strategies. 105 votes, 97% agreed
NB None of the above relate to CIED-detected AHREs.
For more information, please see the supplemental material for the white paper: http://circ.ahajournals.org/content/135/19/1851/tab-supplemental
AF-SCREEN Receives Healthcare Pioneers Award
The Atrial Fibrillation Association (AFA) is a UK registered charity which focuses on raising awareness of atrial fibrillation by providing information and support materials for patients and medical professionals involved in detecting, diagnosing and managing atrial fibrillation.
The AF Association Healthcare Pioneers Report identifies best practice in the identification, diagnosis, treatment and care of patients with atrial fibrillation (AF) and is used as a benchmark to improve services and care for the patients with AF. All entries were reviewed by an AF expert judging committee established from the AF Association Medial Advisory Committee & Arrhythmia Alliance Executive Committee.
Winners were announced at the Arrhythmia Alliance Awards at Heart Rhythm Congress (HRC) 2017. One of the winners was the AF-SCREEN International Collaboration.
For more information: http://www.heartrhythmalliance.org/afa/uk/healthcare-pioneers