04221nas a2200841   4500000000100000008004100001100001900042700001700061700001800078700001600096700001700112700001800129700001700147700001400164700001700178700001900195700002300214700002100237700002100258700002000279700002100299700002300320700001700343700001700360700001600377700001800393700002100411700002200432700001700454700001800471700002000489700001700509700002000526700001900546700001700565700002000582700001600602700001700618700001900635700002000654700001600674700001800690700001800708700002100726700002000747700002000767700002100787700001800808700002000826700002500846700002100871700002100892700002000913700001800933700002100951700002000972700001900992700002501011700002001036700001901056700001801075700002501093700002401118700001501142700001701157700001401174700002801188245009401216300001401310490000801324520203301332022001403365       2017                            d1 aAnderson Craig1 aWang Jiguang1 aHillis Graham1 aNeubeck Lis1 aGwynne Kylie1 aHankey Graeme1 aFreedman Ben1 aCamm John1 aCalkins Hugh1 aHealey Jeffrey1 aRosenqvist Mårten1 aAlbert Christine1 aAntoniou Sotiris1 aBenjamin Emelia1 aBoriani Giuseppe1 aBrachmann Johannes1 aBrandes Axel1 aChao Tze-Fan1 aConen David1 aEngdahl Johan1 aFauchier Laurent1 aFitzmaurice David1 aFriberg Leif1 aGersh Bernard1 aGladstone David1 aGlotzer Taya1 aHarbison Joseph1 aHills Mellanie1 aKamel Hooman1 aKirchhof Paulus1 aKowey Peter1 aKrieger Derk1 aW Y Lee Vivian1 aLevin Lars-Åke1 aLip Gregory1 aLobban Trudie1 aLowres Nicole1 aMairesse Georges1 aMartinez Carlos1 aOrchard Jessica1 aPiccini Jonathan1 aPoppe Katrina1 aPotpara Tatjana1 aPuererfellner Helmut1 aRienstra Michiel1 aSandhu Roopinder1 aSchnabel Renate1 aSiu Chung-Wah1 aSteinhubl Steven1 aSvendsen Jesper1 aSvennberg Emma1 aThemistoclakis Sakis1 aTieleman Robert1 aTurakhia Mintu1 aTveit Arnljot1 aUittenbogaart Steven1 aVan Gelder Isabelle1 aVerma Atul1 aWachter Rolf1 aYan Bryan1 aAF-Screen Collaborators00aScreening for Atrial Fibrillation: A Report of the AF-SCREEN International Collaboration.  a1851-18670 v1353 a<p>
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.
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