Should primary care clinicians screen for atrial fibrillation with electrocardiography?

In this updated 2018 review, The US Preventive Services Task Force concludes there is insufficient evidence to recommend screening for atrial fibrillation (AF) with electrocardiography (ECG) in asymptomatic adults (I statement). (LOE = 2a)

US Preventive Services Task Force, Curry SG, Krist AH, et al. Screening for atrial fibrillation with electrocardiography. US Preventive Services Task Force recommendation statement. JAMA 2018;320(5):478-484.  [PMID:30088016]

Practice guideline

Government

Population-based

In this 2018 version, the task force found evidence that systematic screening of asymptomatic adults with ECG will identify more new cases of AF than no screening. However, none of these studies evaluated the effect of screening versus no screening on patient-oriented outcomes. In addition, systematic screening with ECG does not identify more cases than screening with pulse palpation. The task force also found adequate evidence that screening for AF with ECG is associated with an increased risk of harm, including misdiagnosis, additional testing and invasive procedures, and overtreatment with anticoagulant therapy and the associated risk of major bleeding. The American Heart Association, the European Society of Cardiology, and the American Stroke Association recommend active screening for AF in asymptomatic adults, older than 65 years, using pulse assessment followed by ECG, as indicated.