From the, Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden.
J Intern Med. 2021 Apr;289(4):474-492. doi: 10.1111/joim.13217. Epub 2021 Jan 7.
Atrial fibrillation (AF) is a common disease with increasing prevalence, approximately 3.2% in the adult population. In addition, about one third of AF cases are considered asymptomatic. Due to increased longevity, increased detection and increased prevalence of risk factors, the prevalence of AF is expected to at least double by the year 2060. Patients with AF have an increased risk for ischaemic stroke, heart failure, death and cognitive decline. Treatment with oral anticoagulation reduces the risk of ischaemic stroke and mortality, and the effect on cognitive decline is being studied. Based on the increasing prevalence of AF, its often asymptomatic and paroxysmal presentation and the efficacy of oral anticoagulation treatment, screening for AF has been proposed. AF seems to fulfil most of the Wilson-Jungner criteria for screening issued by the World Health Organization, but some knowledge gaps remain, gaps that will be addressed by several ongoing studies. The knowledge gaps in AF screening consist of the magnitude of the net benefit or net harm inflicted by AF screening because the oral anticoagulation treatment will also increase the risk of bleeding, and the psychological effects of AF screening are not very well studied. So far, the AF screening recommendations issued by the European Society of Cardiology have had limited impact on national and regional AF screening activities. Several large-scale AF screening studies will report results on hard endpoints within the next few years, and these results will hopefully manifest AF as a cardiovascular disease which we need to pay more attention to.
心房颤动（AF）是一种常见疾病，其患病率呈上升趋势，成年人中约有 3.2%。此外，约三分之一的 AF 病例被认为是无症状的。由于寿命延长、检测增加和危险因素增加，预计到 2060 年，AF 的患病率至少将翻一番。AF 患者发生缺血性卒中和心力衰竭、死亡和认知能力下降的风险增加。口服抗凝治疗可降低缺血性卒中和死亡率的风险，而其对认知能力下降的影响正在研究中。鉴于 AF 的患病率不断上升、其常无症状和阵发性表现以及口服抗凝治疗的疗效，已经提出了对 AF 进行筛查。AF 似乎符合世界卫生组织（WHO）发布的 Wilson-Jungner 筛查标准中的大多数标准，但仍存在一些知识空白，这些空白将通过几项正在进行的研究来填补。AF 筛查的知识空白包括因 AF 筛查而导致的净获益或净危害的程度，因为口服抗凝治疗也会增加出血风险，并且对 AF 筛查的心理影响研究得还不够充分。到目前为止，欧洲心脏病学会（ESC）发布的 AF 筛查建议对国家和地区的 AF 筛查活动影响有限。几项大规模的 AF 筛查研究将在未来几年内报告硬终点的结果，这些结果有望表明 AF 是一种我们需要更加关注的心血管疾病。
