Screening for Atrial Fibrillation A Report of the AF-SCREEN International Collaboration
Screening for Atrial Fibrillation A Report of the AF-SCREEN International Collaboration
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DOI：
10.1161/circulationaha.116.026693
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发表时间：
2017-05-09
期刊：
影响因子：
37.8
通讯作者：
Yan, Bryan P.
中科院分区：
文献类型：
--
作者：
Freedman, Ben;Camm, John;Yan, Bryan P.
大约10%的缺血性卒中与卒中时首次诊断的房颤（AF）相关。检测无症状房颤将提供一个机会，以防止这些中风，建立适当的抗凝治疗。AF-SCREEN国际合作成立于2015年9月，旨在促进关于AF筛查的讨论和研究，将其作为减少卒中和死亡的战略，并为实施国家特定的AF筛查计划提供宣传。在2016年期间，AF-SCREEN的60名专家成员，包括医生，护士，专职医疗人员，卫生经济学家和患者倡导者，被邀请编写文件草案的部分。2016年8月，51名成员在罗马开会讨论文件草案，并使用德尔菲程序审议其中的关键点。这些关键点强调，在单个时间点或通过2周以上的间歇性ECG记录发现的屏幕检测到的AF不是良性疾病，并且具有额外的卒中因素，具有足够的卒中风险，可以考虑抗凝治疗。关于大规模筛查的方法，手持式ECG设备具有提供指南要求的用于AF诊断的可验证ECG迹线的优点，因此优选作为筛查工具。某些患者群体，如近期发生不确定来源栓塞性卒中（ESUS）的患者，需要对AF进行更密集的监测。筛查的设置包括社区和诊所的各种场所，但它们必须与适当的诊断和管理途径相关联，以便筛查有效。人们认识到，各国和卫生系统之间的卫生资源差异很大，因此AF筛查的设置应针对具体国家和卫生系统。根据目前的知识，这篇白色论文为房颤筛查提供了强有力的案例，同时认识到大型随机结局研究将有助于加强证据基础。
Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country-and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.