Screening strategies for atrial fibrillation in the elderly population: a systematic review and network meta-analysis.

Autor: Whitfield R; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal., Ascenção R; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.; Clínica Universitária de Medicina Geral e Familiar, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal., da Silva GL; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.; Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.; Serviço de Cardiologia, Departamento do Coração e Vasos, Hospital Universitário de Santa Maria-CHULN, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal., Almeida AG; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.; Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.; Serviço de Cardiologia, Departamento do Coração e Vasos, Hospital Universitário de Santa Maria-CHULN, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal., Pinto FJ; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.; Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.; Serviço de Cardiologia, Departamento do Coração e Vasos, Hospital Universitário de Santa Maria-CHULN, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal., Caldeira D; Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal. dgcaldeira@hotmail.com.; Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa-CCUL (CCUL@RISE), CAML, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal. dgcaldeira@hotmail.com.; Serviço de Cardiologia, Departamento do Coração e Vasos, Hospital Universitário de Santa Maria-CHULN, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal. dgcaldeira@hotmail.com.; Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal. dgcaldeira@hotmail.com.; Centro de Estudos de Medicina Baseada na Evidência (CEMBE), Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal. dgcaldeira@hotmail.com.
Jazyk: angličtina
Zdroj: Clinical research in cardiology : official journal of the German Cardiac Society [Clin Res Cardiol] 2023 Jun; Vol. 112 (6), pp. 705-715. Date of Electronic Publication: 2022 Nov 07.
DOI: 10.1007/s00392-022-02117-9
Abstrakt: Opportunistic screening for atrial fibrillation (AF) is currently recommended for patients aged 65 years and older. However, this has recently been called into question by two studies that report that opportunistic screening is no more effective than usual care. Furthermore, there seems to be no consensus on which is the most effective screening strategy (opportunistic or systematic). Thus, we aimed to compare the different AF detection strategies with each other using the methodology of systematic review with network meta-analysis. An electronic database search of MEDLINE, CENTRAL, and EMBASE was performed. In addition, we also searched OpenGrey, experts' knowledge and screened the reference list of included studies or other relevant publications. The search was performed on the 2nd of November of 2020 and updated on the 20th of September of 2021. We performed a random-effects pairwise meta-analysis and a random-effects network meta-analysis within a frequentist framework in an intention to screen analysis. We reported the results as relative risk (RR) with 95% confidence intervals (CI). We assessed the confidence in the evidence using the GRADE framework. Nine studies were included, enrolling 80,665 participants. Pooled effect sizes suggested that systematic screening was effective when compared with usual care (RR 2.11; 95% CI 1.48-3.02; high GRADE confidence) and when compared with opportunistic screening (RR 1.86; CI 1.23-2.82; high GRADE confidence) but no significant difference was found between opportunistic screening and usual care (RR 1.13; 95% CI 0.79-1.63; low GRADE confidence). Systematic screening was the most effective strategy for detecting atrial fibrillation in individuals aged 65 years or older. Opportunistic screening was no more effective than usual care, but the results were weakened by a low quality of evidence due to risk of bias of the included studies and imprecision in the results. PROSPERO registration number: CRD42020218672.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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