Eur Heart J: Is it reasonable to find atrial fibrillation through a watch? Asymptomatic atrial atrial screening costs unclear, study says

Atrial fibrillation is the most common arrhythmia and is expected to double in the next 30 yearsAtrial fibrillation was associated with a 5-fold increase dysploration risk, but anticoagulant therapy reduced the risk by about 65%Atrial fibrillation screening is a method to improve atrial fibrillation detection rate and reduce the incidence of ischemic stroke through early anticoagulantApple Heart Study, presented at the ACC's annual meeting last year, found that the Apple Watch captures atrial fibrillationCurrent guidelines do not recommend atrial fibrillation screening, citing uncertainty about the cost-benefit of systematic screeningrecent, an expert article published in the European Journal of Cardiology may answer many of our questions about asymptomatic atrial atrial fibrillation screening1How many people have undiagnosed atrial fibrillation? Recent estimates byindicate that 15 per cent of patients with atrial fibrillation are currently undiagnosed and 75 per cent of them may need anticoagulant treatmenta single electrocardiogram examination revealed asymptomatic atrial fibrillation, while continuous electrocardiogram monitoring or implantation of etoelectric devices was screened to 50% asymptomatic atrial fibrillationauthors note that the detection rate of asymptomatic atrial fibrillation depends on the population, devices and duration of monitoring2What is the risk of stroke in patients with asymptomatic atrial fibrillation?authors based on current research data, it remains to be seen whether patients with asymptomatic atrial atrial fibrillation have the same level of risk compared to sinus heart rhythms, but those who were screened for asymptomatic atrial atrial fibrillation in the general population will develop the same levelcurrent evidence does not suggest that patients with atrial fibrillation are screened with the same cardiovascular risk or anticoagulant benefits3 What kind of atrial fibrillation is associated with significant stroke risk? about 25 percent of patients with atrial fibrillation had aburstal atrial fibrillation, rather than persistent atrial fibrillation atrial fibrillation load refers to the proportion of time a patient has atrial fibrillation The authors note that while atrial fibrillation loads are not included in risk prediction tools such as CHA2DS2VASc, atrial fibrillation loads appear to be an important factor in predicting stroke risk a systematic review found that persistent and permanent atrial fibrillation was associated with a greater risk of thrombosis and total mortality than aforedos In the ASSERT study, patients with asymptomatic atrial atrial fibrillation for more than 24 hours had a significantly increased risk of stroke or thrombosis compared to patients without atrial fibrillation (HR-3.24), but patients with asymptomatic atrial atrial fibrillation of less than 24 hours did not see an increased risk currently, the diagnosis of atrial fibrillation is based on the test ingress at least 30s for typical arrhythmia Risk stratification of atrial fibrillation load cannot be applied to patients diagnosed with an electrocardiogram stroke risk scores such as CHA2DS2VASc, which have not been proven for long-term atrial fibrillation diagnosis to help determine whether anticoagulant can have a net benefit if existing guidelines were applied to atrial fibrillation detected through expanded screening, atrial fibrillation load would result in excessive anticoagulant therapy, which in turn would lead to a higher risk of anticoagulant bleeding than a reduced risk of stroke other studies have shown that patients with high CHA2DS2VASc scores have a higher risk of stroke regardless of whether they have atrial fibrillation, and that some patients with sinus heart rhythm may benefit from anticoagulant therefore, the authors believe that a new stingrisk stratification may be required to determine the burden of atrial fibrillation and cardiovascular risk factors in patients with atrial fibrillation by expanding screening 4 Atrial fibrillation and asymptomatic vascular brain injury and dementia risk clinically asymptomatic vascular lesions appear to be common in patients with atrial fibrillation and are not related to whether atrial fibrillation is aggressive or persistent therefore, given the aging population and the rising incidence of dementia worldwide, the authors argue that it is important to develop new strategies to prevent cognitive decline in patients with atrial fibrillation however, it is not clear whether asymptomatic infarction and the resulting vascular lesions explain the link between atrial fibrillation and dementia Multiple approaches may link the two, and much of the available evidence comes from relatively small cross-sectional studies 5 Is targeted screening for high-risk groups effective? targeted screening of high-risk groups may significantly reduce the number of people screened In current studies of high-risk patients, about one-third of patients have seen transient atrial fibrillation, in which implanted heart devices or monitors are used for long-term screening of high-risk populations 6 What is the best screening method? in recent years, a series of new technologies have emerged aimed at improving the accuracy and speed of atrial fibrillation testing, including blood pressure monitors, ECG monitors and ubiquitous smartphones and watches that automatically detect pulse rhythms The proliferation of these intelligent medical devices may provide an opportunity for screening for atrial fibrillation authors note that these devices have been screened for longer or more times, contributing to an increase in atrial fibrillation detection rates, but have not yet been compared to the tests As a result, their relative merits, accuracy and role in diagnosis are uncertain and require further evaluation 7 What harm does atrial fibrillation screening do to patients? a recent systematic review of atrial fibrillation screening found no studies to compare the harms of screening with those of unscreened admitted, there are some potential hazards to screening Population-level screening can lead to large numbers of false positive results, which can lead to unnecessary testing and excessive anticoagulant 8 Is screening the most economical and effective way to reduce the risk of atrial fibrillation? current studies do not determine whether screening can improve stroke-related morbidity and mortality or all-cause mortality current management of atrial fibrillation patients is still not ideal Given the known benefits, greater efforts can be made in treating high-risk patients with asymptomatic atrial fibrillation even if future studies prove that atrial fibrillation screening is effective in reducing stroke rates, cost-effectiveness comparisons need to be established with other measures to improve anticoagulant prescriptions 9 What are the future research trends? as atrial fibrillation screening technology continues to evolve, future research needs to answer key questions, such as how heavy the atrial fibrillation load is, based on this best risk layering tool for determining stroke risk large-scale randomized trials of cost-benefit, stroke and mortality help edit these gaps and determine how medical resources can be used effectively in atrial-fibrillation therapy