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

Abstract

BACKGROUND: Recommendations on atrial fibrillation (AF) screening by various scientific societies are inconsistent due to uncertainty about its benefit. This study aimed to summarize data from randomized controlled trials (RCTs) on the impact of AF screening on thromboembolism, major bleeding, and mortality. METHODS AND RESULTS: We searched PubMed/MEDLINE and Embase to identify studies providing relevant data through 5 September 2024. Risk ratios (RRs) for each reported outcome of interest were pooled through a meta-analysis with random effects models. We included six RCTs reporting data from 74 145 individuals. AF screening was associated with higher AF detection compared with no intervention [RR 2.54, 95% confidence interval (CI): 1.57-4.11, P < 0.001], and more common initiation of oral anticoagulation (RR 2.19, 1.51-3.18, P < 0.001). Incident ischaemic stroke (RR 0.93, 0.87-1.00, P = 0.048) and thromboembolism including ischaemic stroke, transient ischaemic attack, or systemic embolism (0.93, 95% CI: 0.87-0.99, P = 0.026) were less frequent in individuals who underwent AF screening vs. controls. There was no difference for major bleeding, (RR 0.99, 95% CI: 0.93-1.06, P = 0.830), haemorrhagic stroke (RR 0.94, 95% CI: 0.80-1.11, P = 0.497) and all-cause mortality (RR 0.99, 95% CI: 0.95-1.02, P = 0.411). CONCLUSION: AF screening might be beneficial, especially in reducing thromboembolic events.