Atrial Fibrillation (AF) Screening to Prevent Stroke: A Public Health Impact Analysis among Adults Aged 65–74 in Greece

Abstract

Atrial fibrillation (AF) is associated with an increased risk of ischemic stroke and may be difficult to diagnose because of its intermittent nature. The feasibility of screening for undiagnosed AF has been demonstrated in several populations. This study aims to model the impact of screening on AF detection and incidence of stroke between 2020 and 2030 versus background diagnosis only, as well as estimate the cost per averted stroke in each screening scenario. A discrete time, stochastic, individual-based model was developed to assess the efficacy of different screening strategies to diagnose AF among adults aged 65–74 in Greece. Two screening approaches were evaluated: a once-off screening with a 12-lead ECG (electrocardiograph) or a 48-hour Holter monitoring followed by a 12-lead ECG. The clinical event for all scenarios was ischemic stroke. Each scenario was assessed (a) in the total undiagnosed population and (b) in high-risk people only (CHA2DS2-VASc score ≥ 3 or 4). Both screening strategies led to better health outcomes (i.e., additional AF cases detected, and strokes avoided) compared to background diagnosis only, across all populations tested, at a manageable cost to the health care system.