From Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Australia (B.F.); St Georges Hospital, London, UK (J.C.); Johns Hopkins University, Baltimore, MD (H.C.); Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H., D.C.); Karolinska Institute, Stockholm, Sweden (M.R., J.E., L.F., E.S.); The Shanghai Institute of Hypertension, Ruijin Hospital, Jiaotong University School of Medicine, China (J.W.); Brigham and Womens Hospital, Harvard Medical School, Boston, MA (C.M.A.); The George Institute for Global Health, Sydney, Australia (C.S.A.); Barts Health NHS Trust, London, UK (S.A.); National Heart, Lung, and Blood Institute and Boston University's Framingham Heart Study, MA (E.J.B.); University of Modena and Reggio Emilia, Italy (G.B.); Klinikum Coburg, Germany (J.B.); Odense University Hospital, Denmark (A.B.); Cardiovascular Research Centre, National Yang-Ming University, Taipei, Taiwan (T.- F.C.); University Hospital, Basel, Switzerland (D.C.); Université François Rabelais, Tours, France (L.F.); University of Birmingham, UK (D.A.F.); Mayo Clinic College of Medicine, Rochester, MN (B.J.G.); University of Toronto, Ontario, Canada (D.J.G., A.V.); Hackensack University Medical Centre, NJ (T.V.G.); Poche Centre, University of Sydney, Australia (K.G.); University of Western Australia, Perth (G.J.H.); Trinity College, Dublin, Ireland (J.H.); Royal Perth Hospital, University of Western Australia (G.S.H.); StopAfib.org, Dallas, TX (M.T.H.); Weill Cornell Medical College, New York (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, UK (P.K.); SWBH and UHB NHS trusts, Birmingham, UK (P.K.); AFNET, Muenster, Germany (P.K.); Lankenau Institute for Medical Research, Wynnewood, OK (P.R.K.); University Hospital of Zurich, Switzerland (D.K.); Chinese University of Hong Kong (V.W.Y.L., B.P.Y.); University of Linköping, Sweden (L.-A.L.); University of Birmingham, UK; Aalborg University, Denmark (G.Y.H.L.); Arrhythmia Alliance, London, UK (T.L.); Charles Perkins Centre, University of Sydney, Australia (N.L.); Cliniques du Sud Luxembourg, Arlon, Belgium (G.H.M.); Institute for Epidemiology Statistics and Informatics, Frankfurt, Germany (C.M.); Edinburgh Napier University, UK (L.N.); Charles Perkins Centre, University of Sydney, Australia (J.O.); Duke University, Durham, NC (J.P.P.); University of Auckland, New Zealand (K.P.); University of Belgrade, Serbia (T.S.P.); KH der Elisabethinen, Ordensklinikum Linz, Austria (H.P.); University of Groningen, University Medical Centre Groningen, The Netherlands (M.R.); University of Alberta, Edmonton, Canada (R.K.S.); University Heart Centre, Hamburg, Germany (R.B.S.); The University of Hong Kong (C.-W.S.); Scripps Translational Science Institute, San Diego, CA (S.S.); Rigshospitalet, The Heart Centre, University of Copenhagen, Denmark (J.H.S.); Ospedale dell'Angelo Venice-Mestre, Venice, Italy (S.T.); Martini Hospital, Groningen, The Netherlands (R.G.T.); Stanford University, CA (M.P.T.); VA Palo Alto Health Care System, CA (M.P.T.); The Department of Medical Research, Bærum Hospital, Rud, Norway (A.T.); Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands (S.B.U.); University of Groningen, University Medical Centre Groningen, The Netherlands (I.C.V.G.); and University of Göttingen, Germany (R.W.).
Circulation. 2017 May 9;135(19):1851-1867. doi: 10.1161/CIRCULATIONAHA.116.026693.
Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.
大约 10%的缺血性中风与首次在中风时诊断出的心房颤动（AF）有关。检测无症状性 AF 将提供一个机会，通过实施适当的抗凝治疗来预防这些中风。AF-SCREEN 国际合作组织于 2015 年 9 月成立，旨在促进关于 AF 筛查的讨论和研究，作为减少中风和死亡的策略，并为实施特定国家的 AF 筛查计划提供支持。2016 年期间，AF-SCREEN 的 60 名专家成员，包括医生、护士、联合健康专业人员、卫生经济学家和患者权益倡导者，应邀编写一份草案文件的章节。2016 年 8 月，51 名成员在罗马举行会议，讨论草案文件，并使用德尔菲法审议由此产生的要点。这些要点强调，在单一时间点或通过 2 周的间歇性心电图记录发现的筛查性 AF 不是良性疾病，并且在存在其他中风因素的情况下，具有足够的中风风险，值得考虑抗凝治疗。关于大规模筛查的方法，手持式心电图设备具有提供指南要求的用于 AF 诊断的可验证心电图轨迹的优势，因此将优先作为筛查工具。某些患者群体，如最近发生不明来源的栓塞性中风（ESUS）的患者，需要更密集地监测 AF。筛查的场所包括社区和诊所的各种场所，但必须与适当诊断和管理的途径相联系，以确保筛查有效。人们认识到，各国和卫生系统之间的卫生资源差异很大，因此 AF 筛查的场所应该是国家和卫生系统特定的。基于目前的知识，本白皮书强烈主张现在就进行 AF 筛查，同时认识到需要进行大型随机结局研究来加强证据基础。
