Langén Ville, Winstén Aleksi K, Airaksinen K E Juhani, Teppo Konsta
Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland.
Faculty of Medicine, Department of Mathematics and Statistics, University of Turku, Turku, Finland.
Ann Med. 2025 Dec;57(1):2457522. doi: 10.1080/07853890.2025.2457522. Epub 2025 Jan 25.
Several randomized controlled trials (RCTs) have investigated the benefits of atrial fibrillation (AF) screening. However, since none have shown a significant reduction in stroke rates, the impact of screening on clinical outcomes remains uncertain.
We conducted a systematic review and meta-analysis of RCTs reporting clinical outcomes of systematic AF screening in participants without known AF. Pooled risk ratios (RRs) were computed for all-cause stroke or systemic embolism, major bleeding, and all-cause mortality, comparing screening with no screening.
Seven RCTs encompassing 76 458 participants were identified. One trial utilized implantable loop recorders for rhythm monitoring, while the others employed non-invasive screening methods. Pooled results indicated that AF screening was associated with a significant reduction in all-cause stroke or systemic embolism (RR 0.932, 95% CI 0.873-0.996, I = 0%, = 0.037), but had no effect on major bleeding (RR 0.996, 95% CI 0.935-1.060, I = 0%, = 0.876) or all-cause mortality (RR 0.987, 95% CI 0.945-1.031, I = 0%, = 0.550). We estimated a number needed to screen of 148 to prevent one stroke or systemic embolism over a 10-year period in a population of 75-year-olds. When only non-invasive screening methods were considered, the reduction in strokes was not statistically significant (RR 0.942, 95% CI 0.880-1.008, I = 0%, = 0.083).
Systematic AF screening is associated with a modest yet statistically significant 7% relative reduction in stroke and systemic embolism, with no observed impact on major bleeding or all-cause mortality.
多项随机对照试验（RCT）研究了心房颤动（AF）筛查的益处。然而，由于尚无试验显示卒中发生率有显著降低，筛查对临床结局的影响仍不确定。
我们对报告在无已知AF参与者中进行系统性AF筛查临床结局的RCT进行了系统评价和荟萃分析。计算了全因性卒中或全身性栓塞、大出血和全因性死亡的合并风险比（RR），比较了筛查与未筛查的情况。
共纳入7项RCT，涉及76458名参与者。1项试验使用植入式环路记录仪进行心律监测，其他试验采用非侵入性筛查方法。汇总结果表明，AF筛查与全因性卒中或全身性栓塞显著降低相关（RR 0.932，95%CI 0.873 - 0.996，I² = 0%，P = 0.037），但对大出血（RR 0.996，95%CI 0.935 - 1.060，I² = 0%，P = 0.876）或全因性死亡（RR 0.987，95%CI 0.945 - 1.031，I² = 0%，P = 0.550）无影响。我们估计，在75岁人群中，每148人进行筛查10年可预防1次卒中或全身性栓塞。仅考虑非侵入性筛查方法时，卒中减少无统计学意义（RR 0.942，95%CI 0.880 - 1.008，I² = 0%，P = 0.083）。
系统性AF筛查与卒中及全身性栓塞相对降低7%相关，虽幅度不大但具有统计学意义，且未观察到对大出血或全因性死亡有影响。
