Atrial fibrillation screening and clinical outcomes: a meta-analysis of randomized controlled trials.

Background: Recommendations on atrial fibrillation (AF) screening by various scientific societies are inconsistent due to uncertainty about its benefit. This study aimed to summarize data from randomized controlled trials (RCTs) on the impact of AF screening on thromboembolism, major bleeding, and mortality.

Methods: We searched PubMed/MEDLINE and Embase to identify studies providing relevant data through September 05, 2024. Risk ratios for each reported outcome of interest were pooled through a meta-analysis with random effects models.

Results: We included 6 RCTs reporting data from 74 145 patients. AF screening was associated with higher AF detection compared with no intervention [risk ratio (RR) 2.54, 95% confidence interval (CI): 1.57-4.11, p < 0.001], and more common initiation of oral anticoagulation (RR 2.19, 1.51-3.18, p < 0.001). Incident ischemic stroke (RR 0.93, 0.87-1.00, p = 0.048) and thromboembolism including ischemic stroke, transient ischemic attack, or systemic embolism (0.93, 95% CI: 0.87-0.99, p = 0.026) were less frequent in individuals who underwent AF screening versus controls. There was no difference for major bleeding (RR 0.99, 95% CI: 0.93-1.06, p = 0.830), hemorrhagic stroke (RR 0.94, 95% CI: 0.80-1.11, p = 0.497) and all-cause mortality (RR 0.99, 95% CI: 0.95-1.02, p = 0.411).

Conclusion: Our findings suggest that AF screening might be beneficial, especially in reducing thromboembolic events.