Screening for atrial fibrillation in primary care is not effective (VITAL-AF)

Reference

Lubitz SA, Atlas SJ, Ashburner JM, et al. Screening for atrial fibrillation in older adults at primary care visits: VITAL-AF randomized controlled trial. Circulation 2022;145(13):946-954.

Synopsis

This study, sponsored by the manufacturers of the direct oral anticoagulant apixaban, randomized 16 primary care clinics to provide either screening for atrial fibrillation (AF) using a single-lead handheld electrocardiograph (KardiaMobile) or usual care. Comparable clinics were paired, and then one clinic from each pair was randomly selected to be in the screening group to increase the comparability of the overall groups; the 2 groups were quite similar in demographics, vital signs, and comorbidities. The primary analysis was by intention to treat. Ultimately, the screening practices included 15,393 persons and the usual care practices comprised 15,322 persons. Patients 65 years and older in the screening group were offered screening at each clinic visit; 72% ultimately underwent screening. After one year, there was no difference between groups in the primary outcome of newly diagnosed AF (1.72% screened, 1.59% unscreened; risk difference [RD] 0.13%; 95% CI -0.16% to 0.42%). Per-protocol and as-treated analyses came to the same conclusion. There was also no difference between groups in the likelihood that a patient received a new prescription for an anticoagulant. The authors did some post hoc data dredging and found that among patients 85 years or older, there was a significantly greater likelihood of being diagnosed with AF in the screened group (5.6% vs 3.8%; RD 1.8%; 0.18% - 3.3%).