Still Not Enough Evidence for AF Screening: USPSTF

The US Preventive Services Task Force (USPSTF) maintains that there is insufficient evidence to weigh the balance between benefits and harms associated with screening for atrial fibrillation (AF) in asymptomatic adults 50 and older, according to draft documents released Tuesday.

The group first weighed in on the issue in 2018 when it released its “I” recommendation indicating the lack of adequate information to inform a decision for or against screening, specifically with ECG.

For this update, the USPSTF expanded its review to include other screening modalities, including automated blood pressure cuffs, pulse oximeters, and consumer devices using photoplethysmography, but came to the same conclusion.

Though there is enough evidence showing that intermittent and continuous screening approaches are better than usual care at detecting previously undiagnosed AF, it’s not clear that one-time strategies are superior, the authors of the draft statement state.

Also, they say, there’s not enough research to show that there are benefits stemming from early detection of the arrhythmia or from the treatment of screen-detected AF, especially when considering short bouts of paroxysmal AF.

And finally, even though there is inadequate evidence regarding direct harm from screening, there are sufficient data to show that use of anticoagulants for stroke prevention in patients with AF is associated with small-to-moderate risks, including major bleeding.

Overall, the USPSTF concludes: “Evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined.”

Major research needs to include randomized trials of screening versus usual care that are designed to assess both health outcomes and harms; investigations of ways to optimize the accuracy of screening tests and strategies; and studies providing a better understanding of stroke risks and the utility of anticoagulation in subclinical AF.

Accompanying the draft recommendations on the USPSTF website is the draft evidence statement. The documents are open for public comments until May 17.