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Background Atrial fibrillation (AF) screening is endorsed by certain guidelines for individuals aged ≥65 years. Yet many AF screening strategies exist, including the use of wrist-worn wearable devices, and their comparative effectiveness is not well-understood. Methods and Results We developed a decision-analytic model simulating 50 million individuals with an age, sex, and comorbidity profile matching the United States population aged ≥65 years (ie, with a guideline-based AF screening indication). We modeled no screening, in addition to 45 distinct AF screening strategies (comprising different modalities and screening intervals), each initiated at a clinical encounter. The primary effectiveness measure was quality-adjusted life-years, with incident stroke and major bleeding as secondary measures. We defined continuous or nearly continuous modalities as those capable of monitoring beyond a single time-point (eg, patch monitor), and discrete modalities as those capable of only instantaneous AF detection (eg, 12-lead ECG). In total, 10 AF screening strategies were effective compared with no screening (300-1500 quality-adjusted life-years gained/100 000 individuals screened). Nine (90%) effective strategies involved use of a continuous or nearly continuous modality such as patch monitor or wrist-worn wearable device, whereas 1 (10%) relied on discrete modalities alone. Effective strategies reduced stroke incidence (number needed to screen to prevent a stroke: 3087-4445) but increased major bleeding (number needed to screen to cause a major bleed: 1815-4049) and intracranial hemorrhage (number needed to screen to cause intracranial hemorrhage: 7693-16 950). The test specificity was a highly influential model parameter on screening effectiveness. Conclusions When modeled from a clinician-directed perspective, the comparative effectiveness of population-based AF screening varies substantially upon the specific strategy used. Future screening interventions and guidelines should consider the relative effectiveness of specific AF screening strategies.

背景

某些指南推荐对年龄≥65 岁的个体进行心房颤动（AF）筛查。然而，存在许多 AF 筛查策略，包括使用腕戴式可穿戴设备，但其相对有效性尚不清楚。

方法和结果

我们开发了一个决策分析模型，模拟了 5000 万具有与美国≥65 岁人群年龄、性别和合并症谱相匹配的个体（即具有基于指南的 AF 筛查指征）。我们构建了不进行筛查以及 45 种不同的 AF 筛查策略（包括不同的模式和筛查间隔）的模型，每种策略均在临床就诊时开始。主要有效性衡量指标为质量调整生命年，以卒中事件和大出血为次要衡量指标。我们将连续或几乎连续的模式定义为能够监测多个时间点的模式（例如贴片监测仪），而离散模式则定义为只能即时检测 AF 的模式（例如 12 导联心电图）。与不筛查相比，共有 10 种 AF 筛查策略有效（每 100000 例筛查可获得 300-1500 个质量调整生命年）。9 种（90%）有效的策略涉及使用连续或几乎连续的模式，例如贴片监测仪或腕戴式可穿戴设备，而 1 种（10%）仅依赖离散模式。有效的策略降低了卒中发生率（每筛查 3087-4445 例可预防 1 例卒中），但增加了大出血（每筛查 1815-4049 例可导致 1 例大出血）和颅内出血（每筛查 7693-16950 例可导致颅内出血）。测试特异性是影响筛查效果的高度重要模型参数。