Screening for atrial fibrillation increases the chance of preventing a stroke and also saves money

Screening for atrial fibrillation increases the chance of preventing a stroke and also saves money

Atrial fibrillation is the biggest risk factor for a stroke. Screening to detect atrial fibrillation in older people would not only increase the chance of preventing a stroke, it would also save the health care system and society money. This is the result of research conducted at Linköping University and Karolinska Institutet in Sweden and published in the European Heart Journal.

The biggest benefit of screening is that it gives you information that can be used to reduce a person’s risk of stroke and therefore help them live longer with a good quality of life.”

Emma Svennberg, specialist in cardiology at Karolinska University Hospital and associated researcher at Karolinska Institute

A systematic screening program for atrial fibrillation is not used worldwide. The researchers who conducted the present study calculated the cost-effectiveness of screening for atrial fibrillation in people aged 75 to 76 years and concluded that there are good reasons for introducing such a program.

"Our health economic analysis shows that screening is an intervention that even saves money. What I mean is - screening not only saves lives by preventing strokes, but also saves money for the healthcare system," says Lars-Åke Levin, professor in the Department of Health, Medicine and Caring Sciences and director of the Center for Medical Technology Assessment at the university Linkoping.

Some of those who have atrial fibrillation have symptoms, but many of those who have the disease are unaware of it. In atrial fibrillation, parts of the heart known as the atria move extremely quickly and the pumping capacity of the atria is reduced. When this happens, blood clots can form in the heart. These can then travel from the heart to the brain and cause a stroke.

The risk of stroke is five times higher in people with atrial fibrillation than in the general population. However, blood thinning treatment (anticoagulants) is available that can prevent blood clots from forming. Screening will allow the healthcare system to identify people with atrial fibrillation even without symptoms and offer them anticoagulants, thereby reducing their risk of stroke.

Previous health economic analyzes of the value of screening for atrial fibrillation are based on data from the literature and some assumptions. The current study differs from these in that it is based on data from a clinical trial, STROKESTOP, the results of which were published in The Lancet in 2021. This study was led by Karolinska Institutet. STROKESTOP is the world's largest clinical trial for screening for atrial fibrillation. It studied 30,000 people aged 75 to 76 who were randomly assigned to one of two groups. One group was offered the opportunity to participate in screening, while the other group acted as a control group. Cases of atrial fibrillation detected during screening were treated with anticoagulants.

"The screening is a very simple procedure. Basically, your thumbs are placed on a portable ECG device that measures heart activity twice a day for two weeks," says Emma Svennberg.

In the economic evaluation, researchers took into account that some screenings offered will decline.

"Those who accept screening are generally healthier than those who refuse it. Nevertheless, our results show that screening saves money and improves public health. I hope that decision-makers and the health system take note of our results. We show that in this way one of our most serious diseases can be prevented," says Lars-Åke Levin.

The study was financially supported by donors including the Swedish Heart-Lung Foundation and the Stockholm County Council.

Source:

Linköping University

Reference:

Lyth, J., et al. (2022) Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP trial. European Heart Journal. doi.org/10.1093/eurheartj/ehac547.

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