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USPSTF 2018: insufficient evidence to recommend screening for AFib with ECG (I statement)
Clinical Question
Should primary care clinicians screen for atrial fibrillation with electrocardiography?
Bottom line
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). 2a
Reference
Study design: Practice guideline
Funding: Government
Setting: Population-based
Synopsis
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.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Good poem
Cheaper and faster to check the pulse as the FIRST screen in all cases
How absolutely rational
My patients get an ECG once per year. I have patients with slow AF that can 0only be picked up on ECG. The decision to treat with anticoagulants is a different story
I think this should be considered as evidence that pulse should be checked on a regular basis on patients over a certain age. I have found undiagnosed a. fib in a number of patients during my initial consultation visit as a specialist. I must say, even though I have had excellent family doctors over the years, no one has ever taken my pulse.
We are tired of one group telling another group what to do. It takes time away from doing important things and encourages identity politics. At its worst it drives down the value of true insight and suggestions . It encourages kickback against perceived elites and is partially responsible for the present political mood.
The problem with the study is this: if you don’t look, you don’t see. The fact is the maligned ECG is a door-opener to prudent clinical investigation. Not all atrial fibrillation needs invasive and treatment harms.
Taking a pulse definitely takes far less time and is far cheaper than ordering a !2 lead for this purpose. Both are just a snapshot in time so can't see why one is better than the other. Would be interesting though to do a quick study to see how well clinicians can recognize (or at least suspect) A-fib by taking a pulse. Great resident project!
I routinely palpate pulse on all patients with HTN, and all patients 55 or older. I have diagnosed several patients under 65 with A Fib who are asymptomatic