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Stroke is not uncommonly the first clinical manifestation of atrial fibrillation (AF). Although ACC guidelines do not mention screening, ESC 2012 guidelines now recommend opportunistic screening for AF in patients ≥ 65, but the prognosis of incidentally detected asymptomatic AF that might be detected on screening is not known.
The UK Clinical Practice Research Datalink (primary care data from general practices with linkage to hospital discharge diagnoses and causes of death) was interrogated to generate a cohort of patients with incident asymptomatic AF (IA-AF) detected in general practice. An age, gender and index day (day of IA-AF diagnosis) matched cohort of patients without AF was selected at random in a ratio of 5:1. Both cohorts were followed for 3 years.
We identified 9,714 patients with IA-AF and 44,024 matched non-AF controls, mean age 70.5±10, 57% male. Mean CHA2DS2-VASc scores were 2.5 and 2.2 resp (p<0.001). Stroke risk was significantly higher in the IA-AF cohort (Figure). Incidence rate per 100 patient years (IR) (95% CI) for IA-AF vs matched controls, excess IR was: 1.8 (1.65-2.0) vs 0.7 (0.66–0.76), excess 1.1 (0.9–1.3) for stroke; 0.75 (0.65–0.88) vs 0.51 (0.47–0.56), excess 0.24 (0.12-0.36) for MI; and 3.9 (3.6–4.1) vs 1.95 (1.87–2.03), excess 1.9 (1.6–2.2) for mortality.
Incidentally detected asymptomatic AF is not benign, with high excess rates of stroke, MI and death in the first 3 years after diagnosis, justifying a recommendation to screen.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT VII
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1236-41
- 2013 American College of Cardiology Foundation