This policy is currently being reviewed as part of the UK NSC's regular review cycle of all policies. The review process began in January 2010 and is estimated to be completed by May 2014.
The UK NSC invited comments and feedback on the expert review during the consultation period that lasts from 24/12/2013 until 24/03/2014.
Introduction:
1. This paper reviews screening of people aged 65 years and over for atrial fibrillation (AF) against the UK National Screening Committee Criteria for appraising the viability, effectiveness and appropriateness of a screening programme (National Screening Committee 2003). It is based on a literature search conducted by the National Screening Committee in July 2010, with an update using the same search strategy in December 2011. People with AF have an irregular pulse, a clinical sign which is easily detected and can lead to diagnosis or exclusion of AF through an electrocardiogram (ECG). Those in whom AF is confirmed can be offered treatment to reduce their risk of having a stroke. In 2005 a Health Technology Assessment (HTA) concluded that opportunistic screening is the most cost-effective method to identify AF in a community population aged 65 years and over (Hobbs et al 2005). That HTA included a randomised controlled trial (RCT), but its scope was restricted by the funding body to the case identification component of screening, so the effects of treatment for screen-detected AF were not assessed.
The Condition
The condition should be an important health problem
2. AF is a major risk factor for stroke, leading to a fivefold increase in risk (Wolf et al 1991). The proportion of strokes associated with AF increases progressively with age, ranging from 7% in individuals aged 50-59 years to 36% in those aged 80-89 years (Wolf et al 1991, Arboix et al 2008). The prevalence of AF among people in the UK aged 65 and over is approximately 7%. A recent population-based study from Dublin found that the crude incidence rate of all AF-associated stroke is approximately 60 per 100,000 person years (Hannon et al 2010), which equates to about 35,000 strokes per annum in the UK. Another source states that AF accounts for about a sixth of all strokes (Raju and Hankey 2010), an estimate that equates to about 25,000 strokes per annum in the UK.
Comments on UK National Screening Committee
Screening for Atrial Fibrillation in People aged 65 and over - A draft report
The Royal College of Physicians of Edinburgh is pleased to respond to the UK National Screening Committee on its draft report on Screening for Atrial Fibrillation in People aged 65 and over.
The College is very supportive of such a screening programme and notes that the draft report refers in several places to our recent Consensus Statement on AF. Our advice is that screening should continue, and we draw your attention to a recent Australian review which may also be helpful.
Screening to identify unknown atrial fibrillation: A systematic review, Nicole Lowres; Lis Neubeck; Julie Redfern; S. Ben Freedman. University of Sydney, ANZAC Research Institute and Department of Cardiology, Concord Hospital, Sydney, New South Wales, Australia; The George Institute for Global Health, Sydney, New South Wales, Australia. (Thrombosis and Haemostasis” 110.2/2013).
Also, the field has changed with the availability of new technologies to support opportunistic screening and we draw your attention to an earlier Australian Study, again from the Concord Hospital team and published by the BMJ.
Screening Education and Recognition in Community Pharmacies of Atrial Fibrillation to prevent stroke in an ambulant population aged >=65 years (SEARCH-AF stroke prevention study): a cross-sectional study protocol. Lowres N, Freedman SB, Redfern J, McLachlan A, Krass I, Bennett A, Briffa T, Bauman A, Neubeck L. (BMJ Open. 2012 Jun 25;2(3). pii: e001355. doi: 10.1136/bmjopen-2012-001355. Print 2012).