Screening for atrial fibrillation to prevent stroke: a meta-analysis

Aims: We aimed to summarize existing evidence from published randomized trials that assessed atrial fibrillation (AF) screening for stroke prevention. Methods and results: We searched MEDLINE for randomized trials that enrolled patients without known AF, screened for AF using electrocardiogram-based methods, and reported stroke outcomes. For this analysis, we excluded studies that focused on post-stroke populations. We combined data using a random-effects model and performed trial sequential meta-analysis using an O'Brien-Fleming alpha-spending function.We identified four randomized clinical trials with a total of 35 836 participants. The populations, screening intervention, and definition of stroke varied markedly. As compared with no screening, AF screening was associated with a reduction in stroke (relative risk 0.91; 95% confidence interval: 0.84-0.99]. Trial sequential meta-analysis found that the cumulative z-score did not cross the stopping boundary.After polling members of the AF-SCREEN and AFFECT-EU consortia, we identified a further 12 trials that are complete but have not yet reported stroke outcomes or are ongoing and expected to collect stroke outcomes. These consortia are planning an individual participant data meta-analysis which will permit the exploration of methodological heterogeneity. Conclusions: If and how to screen for AF is an important public health concern. The body of evidence published to date suggests that AF could be effective to prevent strokes in some settings. The AF-SCREEN/AFFECT-EU individual patient data meta-analysis aims to comprehensively assess the benefits and risks of AF screening, and determine how population, screening method, and health-system factors influence stroke prevention.