Refined atrial fibrillation screening and cost-effectiveness in the German population
| Autor: | Matthias Buettner, Christopher Wallenhorst, Carlos Martinez, Philipp S. Wild, Thomas Münzel, Karl J. Lackner, Matthias Michal, Ngoc Anh Spruenker, Ben Freedman, Stefan Blankenberg, Norbert Pfeiffer, Daniel Engler, Renate B. Schnabel |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis Population 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine Atrial Fibrillation Natriuretic Peptide Brain Epidemiology Humans Medicine 030212 general & internal medicine Risk factor education Stroke Aged Heart Failure education.field_of_study business.industry Atrial fibrillation Middle Aged medicine.disease Peptide Fragments 3. Good health Heart failure Biomarker (medicine) Female Cardiology and Cardiovascular Medicine business Biomarkers |
| Zdroj: | Heart |
| ISSN: | 1468-201X 1355-6037 |
| Popis: | ObjectiveLittle is known on optimal screening population for detecting new atrial fibrillation (AF) in the community. We describe characteristics and estimate cost-effectiveness for a single timepoint electrocardiographic screening.MethodsWe performed a 12-lead ECG in the German population-based Gutenberg Health Study between 2007 and 2012 (n=15 010), mean age 55±11 years, 51% men and collected more than 120 clinical and biomarker variables, including N-terminal pro B-type natriuretic peptide (Nt-proBNP), risk factors, disease symptoms and echocardiographic variables.ResultsOf 15 010 individuals, 466 (3.1%) had AF. New AF was found in 32 individuals, 0.2% of the total sample, 0.5% of individuals aged 65–74 years and predominantly men (86%). The classical risk factor burden was high in individuals with new AF. The median estimated stroke risk was 2.2%/year, while risk of developing heart failure was 21% over 10 years. In the 65–74 year age group, the cost per quality-adjusted life-year gained resulting from a single timepoint screening was €30 361. In simulations, the costs were highly sensitive to AF detection rates, proportion of treatment and type of oral anticoagulant. Prescreening by Nt-proBNP measurements was not cost-effective in the current setting.ConclusionsIn our middle-aged population cohort, we identified 0.2% new AF by single timepoint screening. There was a significant estimated risk of stroke and heart failure in these individuals. Cost-effectiveness for screening may be reached in individuals aged 65 years and older. The simple age cut-off is not improved by using Nt-proBNP as a biomarker to guide a screening programme. |
| Databáze: | OpenAIRE |
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