Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Mörbygårdsvägen 5, Stockholm, Sweden.
Department of Research and Development, Halland Hospital, Halmstad, Sweden.
Europace. 2018 Nov 1;20(FI_3):f306-f311. doi: 10.1093/europace/euy045.
Thrombo-embolic stroke risk in atrial fibrillation (AF) is significantly reduced with oral anticoagulant (OAC) treatment. Atrial fibrillation is often asymptomatic (silent) and therefore undiagnosed. The long-term course of silent AF as well as OAC treatment adherence after AF screening is not known. We aim at studying long-term adherence to OAC treatment, AF symptoms, and stroke incidence on population level after systematic AF screening.
All inhabitants in a Swedish municipality who were born in 1934 and 1935 (n = 1335) were invited to participate in an AF screening trial between 2010 and 2012. Participants with a previously known or screening-detected AF were invited to a 5-year follow-up. Time trends of ischaemic stroke incidence were compared for population groups residing in the intervention municipality and in a surrounding control area where no AF screening trial was carried out. After the screening procedure, 103 of 121 participants (85%) with AF were treated with OAC. At the follow-up examination, 94 of 106 living patients (88%) were still on OAC treatment. Among the 23 long-term surviving patients who were diagnosed with paroxysmal AF during screening, 6 had developed permanent silent AF. The incidence of ischaemic stroke between ages 76-80 years declined significantly after the AF screening trial in the intervention area (P = 0.003) but not in the control area.
Adherence to OAC treatment 5 years after AF screening was high. Silent AF has a natural course similar to symptomatic AF. The observed incidences of ischaemic stroke suggest a beneficial population-level effect of systematic AF screening.
心房颤动（AF）患者血栓栓塞性中风的风险可通过口服抗凝剂（OAC）治疗显著降低。AF 常无症状（无症状），因此无法诊断。无症状 AF 的长期病程以及 AF 筛查后 OAC 治疗的依从性尚不清楚。我们旨在研究系统 AF 筛查后人群中 OAC 治疗的长期依从性、AF 症状和中风发生率。
邀请 1934 年和 1935 年出生的瑞典一个市的所有居民参加 2010 年至 2012 年的 AF 筛查试验。邀请有先前已知或筛查发现的 AF 的参与者参加 5 年随访。比较居住在干预市和未进行 AF 筛查试验的周边对照区的人群中缺血性中风发生率的时间趋势。在筛查程序后，121 名 AF 患者中有 103 名（85%）接受了 OAC 治疗。在随访检查时，106 名存活患者中有 94 名（88%）仍在接受 OAC 治疗。在筛查时被诊断为阵发性 AF 的 23 名长期存活患者中，有 6 名发展为永久性无症状 AF。在干预区，AF 筛查试验后 76-80 岁年龄组的缺血性中风发生率显著下降（P=0.003），但在对照区没有下降。
AF 筛查后 5 年 OAC 治疗的依从性较高。无症状 AF 具有与有症状 AF 相似的自然病程。观察到的缺血性中风发生率表明系统 AF 筛查具有有益的人群效应。
