预防中风时心房颤动的筛查：随机对照试验的系统评价和荟萃分析
Screening for Atrial Fibrillation in Stroke Prevention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
作者信息
Yang Xueru, Huang Jun, Huang Ziqian, Xue Yumei, Deng Hai, Cao Xi
机构信息
The School of Nursing, Sun Yat-Sen University, 510080 Guangzhou, Guangdong, China.
Department of Geriatrics, Guangdong General Hospital, Institute of Geriatrics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080 Guangzhou, Guangdong, China.
出版信息
Rev Cardiovasc Med. 2025 Jul 23;26(7):36262. doi: 10.31083/RCM36262. eCollection 2025 Jul.
BACKGROUND
Evidence is needed to determine the benefits and harms of screening for atrial fibrillation (AF) in stroke prevention. This meta-analysis aimed to evaluate the benefits and issues of AF screening among older adults.
METHODS
This systematic review and meta-analysis were conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We systematically searched several databases from inception through 28 March 2025, selecting randomized controlled trials (RCTs) comparing AF screening, including systematic and opportunistic screening, versus routine practice or no screening. Two reviewers independently extracted the data and appraised the risks of bias of the studies.
RESULTS
Thirteen articles covering 12 RCTs were included in the meta-analysis. For routine screening, systematic screening, rather than opportunistic screening, was more effective in detecting new AF cases (relative risk (RR), 2.07; 95% CI, 1.41 to 3.04; = 0.0002). However, no difference was observed in the effectiveness of systematic and opportunistic screening in detecting AF (RR, 1.39; 95% CI, 0.59 to 3.30; = 0.45). Compared with no screening, single-time-point screening did not improve the AF detection rate, whereas intermittent/continuous screening was associated with a greater likelihood of detecting AF (RR, 2.40; 95% CI, 1.59 to 3.64; < 0.0001). There were no significant differences in the anticoagulation prescription rate between patients who underwent screening and routine care (RR, 1.16; 95% CI, 0.94 to 1.44; = 0.16). Systematic screening was associated with a lower risk for the composite endpoint (combination of thrombosis-related events and mortality; RR, 0.96; 95% CI, 0.93 to 0.99; = 0.02) but not for the individual endpoints. Compared with routine care, systematic screening did not increase the risk of major bleeding (RR, 0.88; 95% CI, 0.72 to 1.06; = 0.18), whereas a positive screening result could promote anxiety.
CONCLUSIONS
Systematic screening outperformed routine care but was comparable to opportunistic screening in detecting undiagnosed AF. Systematic screening was related to a reduction in the composite endpoints of stroke and all-cause mortality without increasing the risk of bleeding.
PROSPERO REGISTRATION
This systematic review was prospectively registered in PROSPERO, registration number: CRD42024558614, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024558614.
背景
需要证据来确定在预防中风方面筛查心房颤动（AF）的益处和危害。本荟萃分析旨在评估老年人AF筛查的益处和问题。
方法
本系统评价和荟萃分析是按照系统评价和荟萃分析的首选报告项目（PRISMA）声明进行并报告的。我们系统地检索了从数据库建立到2025年3月28日的多个数据库，选择了比较AF筛查（包括系统性筛查和机会性筛查）与常规做法或不筛查的随机对照试验（RCT）。两名评价员独立提取数据并评估研究的偏倚风险。
结果
荟萃分析纳入了涵盖12项RCT的13篇文章。对于常规筛查，系统性筛查而非机会性筛查在检测新发AF病例方面更有效（相对风险（RR），2.07；95%置信区间，1.41至3.04；P = 0.0002）。然而，在检测AF方面，系统性筛查和机会性筛查的有效性未观察到差异（RR，1.39；95%置信区间，0.59至3.30；P = 0.45）。与不筛查相比，单点筛查未提高AF检测率，而间歇性/连续性筛查与检测到AF的可能性更大相关（RR，2.40；95%置信区间，1.59至3.64；P < 0.0001）。接受筛查的患者与接受常规护理的患者之间的抗凝处方率无显著差异（RR，1.16；95%置信区间，0.94至1.44；P = 0.16）。系统性筛查与复合终点（血栓形成相关事件和死亡率的组合）风险较低相关（RR，0.96；95%置信区间，0.93至0.99；P = 0.02），但与个体终点无关。与常规护理相比，系统性筛查未增加大出血风险（RR，0.88；95%置信区间，0.72至1.06；P = 0.18），而阳性筛查结果可能会引发焦虑。
结论
在检测未诊断的AF方面，系统性筛查优于常规护理，但与机会性筛查相当。系统性筛查与降低中风和全因死亡率的复合终点相关，且不增加出血风险。
PROSPERO注册：本系统评价已在PROSPERO中进行前瞻性注册，注册号：CRD42024558614，https://www.crd.york.ac.uk/PROSPERO/view/CRD42024558614 。
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