Atrial fibrillation screening and clinical outcomes: a meta-analysis of randomized controlled trials.

Summary

Across 6 RCTs (n=74,145), AF screening increased AF detection and anticoagulation initiation and modestly reduced ischemic stroke and thromboembolism without increasing major bleeding or mortality. These findings support targeted AF screening programs.

Key Findings

• AF screening doubled AF detection (RR 2.54) and increased oral anticoagulation initiation (RR 2.19).
• Ischemic stroke and composite thromboembolism were modestly reduced (RR 0.93 for both outcomes).
• No increase in major bleeding, hemorrhagic stroke, or all-cause mortality.

Clinical Implications

Implement AF screening in at-risk populations (e.g., older adults) with clear pathways for confirmatory testing and anticoagulation initiation, while monitoring for bleeding and optimizing patient selection.

Limitations

• Heterogeneity in screening modalities, populations, and follow-up across trials
• Modest absolute risk reductions; cost-effectiveness and implementation logistics require evaluation

Future Directions

Head-to-head trials of screening strategies, stratified by age and risk, with health-economic analyses and assessment of downstream care pathways and patient-reported outcomes.