Khurshid, ShaanChen, WanyiSinger, Daniel E.Atlas, Steven J.Ashburner, Jeffrey M.Choi, Jin G.Hur, ChinEllinor, Patrick T.McManus, David DChhatwal, JagpreetLubitz, Steven A.2022-08-232022-08-232021-09-032022-06-02<p>Khurshid S, Chen W, Singer DE, Atlas SJ, Ashburner JM, Choi JG, Hur C, Ellinor PT, McManus DD, Chhatwal J, Lubitz SA. Comparative Clinical Effectiveness of Population-Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision-Analytic Model. J Am Heart Assoc. 2021 Sep 21;10(18):e020330. doi: 10.1161/JAHA.120.020330. Epub 2021 Sep 3. PMID: 34476979; PMCID: PMC8649502. <a href="https://doi.org/10.1161/JAHA.120.020330">Link to article on publisher's site</a></p>2047-9980 (Linking)10.1161/JAHA.120.02033034476979https://hdl.handle.net/20.500.14038/42710Background 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.en-USCopyright © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.http://creativecommons.org/licenses/by-nc-nd/4.0/atrial fibrillationcost‐effectivenessmicrosimulationscreeningCardiologyCardiovascular DiseasesEpidemiologyJournal Articlehttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=5989&amp;context=oapubs&amp;unstamped=1https://escholarship.umassmed.edu/oapubs/495429511287oapubs/4954