title: Is screening for AF worthwhile? Stroke risk in a screened population from the SAFE study.
abstract: BACKGROUND
  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 practices within which cohorts of 200 patients were randomly 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Primary Care Clinical Sciences and.
authors.forename: D A
authors.initials: DA
authors.lastname: Fitzmaurice
authors.affiliation: Primary Care Clinical Sciences and d.mccahon@bham.ac.uk.
authors.forename: D
authors.initials: D
authors.lastname: McCahon
authors.affiliation: Primary Care Clinical Sciences and.
authors.forename: J
authors.initials: J
authors.lastname: Baker
authors.affiliation: Primary Care Clinical Sciences and.
authors.forename: E T
authors.initials: ET
authors.lastname: Murray
authors.affiliation: Health Economics, University of Birmingham, Birmingham, UK and.
authors.forename: S
authors.initials: S
authors.lastname: Jowett
authors.affiliation: Primary Care Clinical Sciences and.
authors.forename: H
authors.initials: H
authors.lastname: Sandhar
authors.affiliation: Primary Care Clinical Sciences and.
authors.forename: R L
authors.initials: RL
authors.lastname: Holder
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: F D R
authors.initials: FD
authors.lastname: Hobbs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; atrial fibrillation; primary care; risk factors; screening; stroke.