[Skip to Content]
[Skip to Content Landing]

Screening for Atrial FibrillationUS Preventive Services Task Force Recommendation Statement

Educational Objective
To review the USPSTF recommendations regarding screening for atrial fibrillation (AF).
1 Credit CME
Abstract

Importance  Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence of AF increases with age, from less than 0.2% in adults younger than 55 years to about 10% in those 85 years or older, with a higher prevalence in men than in women. It is uncertain whether the prevalence of AF differs by race and ethnicity. Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter.

Objective  To update its 2018 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the benefits and harms of screening for AF in older adults, the accuracy of screening tests, the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care, and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older adults.

Population  Adults 50 years or older without a diagnosis or symptoms of AF and without a history of transient ischemic attack or stroke.

Evidence Assessment  The USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined.

Recommendation  The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF. (I statement)

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Karina W. Davidson, PhD, MASc, Feinstein Institutes for Medical Research, 130 E 59th St, Ste 14C, New York, NY 10032 (chair@uspstf.net).

Accepted for Publication: December 16, 2021.

The US Preventive Services Task Force (USPSTF) members: Karina W. Davidson, PhD, MASc; Michael J. Barry, MD; Carol M. Mangione, MD, MSPH; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Esa M. Davis, MD, MPH; Katrina E. Donahue, MD, MPH; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Martha Kubik, PhD, RN; Li Li, MD, PhD, MPH; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; James Stevermer, MD, MSPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York (Davidson); Harvard Medical School, Boston, Massachusetts (Barry); University of California, Los Angeles (Mangione); Albert Einstein College of Medicine, New York, New York (Cabana); Oregon Health & Science University, Portland (Caughey); University of Pittsburgh, Pittsburgh, Pennsylvania (Davis); University of North Carolina at Chapel Hill (Donahue); Mayo Clinic, Rochester, Minnesota (Doubeni); Virginia Tech Carilion School of Medicine, Roanoke (Epling Jr); George Mason University, Fairfax, Virginia (Kubik); University of Virginia, Charlottesville (Li); New York University, New York, New York (Ogedegbe); University of Massachusetts Medical School, Worcester (Pbert); Brown University, Providence, Rhode Island (Silverstein); University of Missouri, Columbia (Stevermer); University of Hawaii, Honolulu (Tseng); Pacific Health Research and Education Institute, Honolulu, Hawaii (Tseng); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Davidson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: USPSTF recommendations are independent of the US Government. They should not be construed as an official position of AHRQ or the Department of Health and Human Services. AHRQ does not mandate national standards of clinical practice or quality health care standards.

Additional Contributions: We thank Howard Tracer, MD (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Published by JAMA®—Journal of the American Medical Association under arrangement with the Agency for Healthcare Research and Quality (AHRQ). ©2022 AMA and United States Government, as represented by the Secretary of the Department of Health and Human Services (HHS), by assignment from the members of the United States Preventive Services Task Force (USPSTF). All rights reserved.

References
1.
Go  AS , Hylek  EM , Phillips  KA ,  et al.  Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study.   JAMA. 2001;285(18):2370-2375. doi:10.1001/jama.285.18.2370PubMedGoogle ScholarCrossref
2.
Kahwati  L , Asher  GN , Kadro  Z ,  et al.  Screening for Atrial Fibrillation: An Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 208. Agency for Healthcare Research and Quality; 2021. AHRQ publication 21-05277.
3.
Wolf  PA , Abbott  RD , Kannel  WB .  Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.   Stroke. 1991;22(8):983-988. doi:10.1161/01.STR.22.8.983PubMedGoogle ScholarCrossref
4.
Wolf  PA , Kannel  WB , McGee  DL , Meeks  SL , Bharucha  NE , McNamara  PM .  Duration of atrial fibrillation and imminence of stroke: the Framingham study.   Stroke. 1983;14(5):664-667. doi:10.1161/01.STR.14.5.664PubMedGoogle ScholarCrossref
5.
Lin  HJ , Wolf  PA , Benjamin  EJ , Belanger  AJ , D’Agostino  RB .  Newly diagnosed atrial fibrillation and acute stroke: the Framingham Study.   Stroke. 1995;26(9):1527-1530. doi:10.1161/01.STR.26.9.1527PubMedGoogle ScholarCrossref
6.
Hannon  N , Sheehan  O , Kelly  L ,  et al.  Stroke associated with atrial fibrillation—incidence and early outcomes in the north Dublin population stroke study.   Cerebrovasc Dis. 2010;29(1):43-49. doi:10.1159/000255973PubMedGoogle ScholarCrossref
7.
US Preventive Services Task Force. Procedure Manual. Published May 2021. Accessed December 6, 2021. https://uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual
8.
Hindricks  G , Potpara  T , Dagres  N ,  et al; ESC Scientific Document Group.  2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).   Eur Heart J. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612PubMedGoogle ScholarCrossref
9.
Noseworthy  PA , Kaufman  ES , Chen  LY ,  et al; American Heart Association Council on Clinical Cardiology Electrocardiography and Arrhythmias Committee; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Stroke Council.  Subclinical and device-detected atrial fibrillation: pondering the knowledge gap: a scientific statement from the American Heart Association.   Circulation. 2019;140(25):e944-e963. doi:10.1161/CIR.0000000000000740PubMedGoogle ScholarCrossref
10.
Benjamin  EJ , Go  AS , Desvigne-Nickens  P ,  et al.  Research priorities in atrial fibrillation screening: a report from a National Heart, Lung, and Blood Institute virtual workshop.   Circulation. 2021;143(4):372-388. doi:10.1161/CIRCULATIONAHA.120.047633PubMedGoogle ScholarCrossref
11.
January  CT , Wann  LS , Alpert  JS ,  et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.   J Am Coll Cardiol. 2014;64(21):e1-e76. doi:10.1016/j.jacc.2014.03.022PubMedGoogle ScholarCrossref
12.
January  CT , Wann  LS , Calkins  H ,  et al; Writing Group Members.  2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.   Heart Rhythm. 2019;16(8):e66-e93. doi:10.1016/j.hrthm.2019.01.024PubMedGoogle ScholarCrossref
13.
Lip  GYH , Banerjee  A , Boriani  G ,  et al.  Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report.   Chest. 2018;154(5):1121-1201. doi:10.1016/j.chest.2018.07.040PubMedGoogle ScholarCrossref
14.
Benjamin  EJ , Muntner  P , Alonso  A ,  et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee.  Heart disease and stroke statistics—2019 update: a report from the American Heart Association.   Circulation. 2019;139(10):e56-e528. doi:10.1161/CIR.0000000000000659PubMedGoogle ScholarCrossref
15.
Mozaffarian  D , Benjamin  EJ , Go  AS ,  et al; Writing Group Members; American Heart Association Statistics Committee; Stroke Statistics Subcommittee.  Heart disease and stroke statistics—2016 update: a report from the American Heart Association.   Circulation. 2016;133(4):e38-e360. doi:10.1161/CIR.0000000000000350PubMedGoogle Scholar
16.
Menke  J , Lüthje  L , Kastrup  A , Larsen  J .  Thromboembolism in atrial fibrillation.   Am J Cardiol. 2010;105(4):502-510. doi:10.1016/j.amjcard.2009.10.018PubMedGoogle ScholarCrossref
17.
Benjamin  EJ , Virani  SS , Callaway  CW ,  et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee.  Heart disease and stroke statistics—2018 update: a report from the American Heart Association.   Circulation. 2018;137(12):e67-e492. doi:10.1161/CIR.0000000000000558PubMedGoogle ScholarCrossref
18.
Krist  AH , Davidson  KW , Mangione  CM ,  et al; US Preventive Services Task Force.  Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement.   JAMA. 2021;325(16):1650-1656. doi:10.1001/jama.2021.4987PubMedGoogle Scholar
19.
Bibbins-Domingo  K , Grossman  DC , Curry  SJ ,  et al; US Preventive Services Task Force.  Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement.   JAMA. 2016;316(19):1997-2007. doi:10.1001/jama.2016.15450PubMedGoogle Scholar
20.
Krist  AH , Davidson  KW , Mangione  CM ,  et al; US Preventive Services Task Force.  Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force recommendation statement.   JAMA. 2021;325(3):265-279. doi:10.1001/jama.2020.25019PubMedGoogle Scholar
21.
Krist  AH , Davidson  KW , Mangione  CM ,  et al; US Preventive Services Task Force.  Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force Recommendation Statement.   JAMA. 2020;324(20):2069-2075. doi:10.1001/jama.2020.21749PubMedGoogle Scholar
22.
Curry  SJ , Krist  AH , Owens  DK ,  et al; US Preventive Services Task Force.  Screening for atrial fibrillation with electrocardiography: US Preventive Services Task Force recommendation statement.   JAMA. 2018;320(5):478-484. doi:10.1001/jama.2018.10321PubMedGoogle Scholar
23.
Kahwati  LC , Asher  GN , Kadro  ZO ,  et al.  Screening for atrial fibrillation: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. Published January 25, 2021. doi:10.1001/jama.2021.21811Google Scholar
24.
Himmelreich  JCL , Karregat  EPM , Lucassen  WAM ,  et al.  Diagnostic accuracy of a smartphone-operated, single-lead electrocardiography device for detection of rhythm and conduction abnormalities in primary care.   Ann Fam Med. 2019;17(5):403-411. doi:10.1370/afm.2438PubMedGoogle ScholarCrossref
25.
Kearley  K , Selwood  M , Van den Bruel  A ,  et al.  Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors.   BMJ Open. 2014;4(5):e004565. doi:10.1136/bmjopen-2013-004565PubMedGoogle Scholar
26.
Sabar  MI , Ara  F , Henderson  A ,  et al.  A study to assess a novel automated electrocardiogram technology in screening for atrial fibrillation.   Pacing Clin Electrophysiol. 2019;42(10):1383-1389. doi:10.1111/pace.13800PubMedGoogle ScholarCrossref
27.
Wiesel  J , Arbesfeld  B , Schechter  D .  Comparison of the Microlife blood pressure monitor with the Omron blood pressure monitor for detecting atrial fibrillation.   Am J Cardiol. 2014;114(7):1046-1048. doi:10.1016/j.amjcard.2014.07.016PubMedGoogle ScholarCrossref
28.
Marazzi  G , Iellamo  F , Volterrani  M ,  et al.  Comparison of Microlife BP A200 Plus and Omron M6 blood pressure monitors to detect atrial fibrillation in hypertensive patients.   Adv Ther. 2012;29(1):64-70. doi:10.1007/s12325-011-0087-0PubMedGoogle ScholarCrossref
29.
Philippsen  TJ , Christensen  LS , Hansen  MG , Dahl  JS , Brandes  A .  Detection of subclinical atrial fibrillation in high-risk patients using an insertable cardiac monitor.   JACC Clin Electrophysiol. 2017;3(13):1557-1564. doi:10.1016/j.jacep.2017.06.020PubMedGoogle ScholarCrossref
30.
Hobbs  FD , Fitzmaurice  DA , Mant  J ,  et al.  A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over: the SAFE study.   Health Technol Assess. 2005;9(40):iii-iv, ix-x, 1-74. doi:10.3310/hta9400PubMedGoogle ScholarCrossref
31.
Fitzmaurice  DA , Hobbs  FD , Jowett  S ,  et al.  Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial.   BMJ. 2007;335(7616):383. doi:10.1136/bmj.39280.660567.55PubMedGoogle ScholarCrossref
32.
Mant  J , Fitzmaurice  DA , Hobbs  FD ,  et al.  Accuracy of diagnosing atrial fibrillation on electrocardiogram by primary care practitioners and interpretative diagnostic software: analysis of data from Screening for Atrial Fibrillation in the Elderly (SAFE) trial.   BMJ. 2007;335(7616):380. doi:10.1136/bmj.39227.551713.AEPubMedGoogle ScholarCrossref
33.
Swancutt  D , Hobbs  R , Fitzmaurice  D ,  et al.  A randomised controlled trial and cost effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in the over 65s: (SAFE) [ISRCTN19633732].   BMC Cardiovasc Disord. 2004;4:12. doi:10.1186/1471-2261-4-12PubMedGoogle ScholarCrossref
34.
Morgan  S , Mant  D .  Randomised trial of two approaches to screening for atrial fibrillation in UK general practice.   Br J Gen Pract. 2002;52(478):373-374, 377-380. PubMedGoogle Scholar
35.
Kaasenbrood  F , Hollander  M , de Bruijn  SH ,  et al.  Opportunistic screening versus usual care for diagnosing atrial fibrillation in general practice: a cluster randomised controlled trial.   Br J Gen Pract. 2020;70(695):e427-e433. doi:10.3399/bjgp20X708161PubMedGoogle ScholarCrossref
36.
Uittenbogaart  SB , Verbiest-van Gurp  N , Lucassen  WAM ,  et al.  Opportunistic screening versus usual care for detection of atrial fibrillation in primary care: cluster randomised controlled trial.   BMJ. 2020;370:m3208. doi:10.1136/bmj.m3208PubMedGoogle Scholar
37.
Halcox  JPJ , Wareham  K , Cardew  A ,  et al.  Assessment of remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study.   Circulation. 2017;136(19):1784-1794. doi:10.1161/CIRCULATIONAHA.117.030583PubMedGoogle ScholarCrossref
38.
Svennberg  E , Friberg  L , Frykman  V , Al-Khalili  F , Engdahl  J , Rosenqvist  M .  Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial.   Lancet. 2021;398(10310):1498-1506. doi:10.1016/S0140-6736(21)01637-8PubMedGoogle ScholarCrossref
39.
Steinhubl  SR , Waalen  J , Edwards  AM ,  et al.  Effect of a home-based wearable continuous ECG monitoring patch on detection of undiagnosed atrial fibrillation: the mSToPS randomized clinical trial.   JAMA. 2018;320(2):146-155. doi:10.1001/jama.2018.8102PubMedGoogle ScholarCrossref
40.
Gladstone  DJ , Wachter  R , Schmalstieg-Bahr  K ,  et al; SCREEN-AF Investigators and Coordinators.  Screening for atrial fibrillation in the older population: a randomized clinical trial.   JAMA Cardiol. 2021;6(5):558-567. doi:10.1001/jamacardio.2021.0038PubMedGoogle ScholarCrossref
41.
Tereshchenko  LG , Henrikson  CA , Cigarroa  J , Steinberg  JS .  Comparative effectiveness of interventions for stroke prevention in atrial fibrillation: a network meta-analysis.   J Am Heart Assoc. 2016;5(5):e003206. doi:10.1161/JAHA.116.003206PubMedGoogle Scholar
42.
Meschia  JF , Bushnell  C , Boden-Albala  B ,  et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension.  Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.   Stroke. 2014;45(12):3754-3832. doi:10.1161/STR.0000000000000046PubMedGoogle ScholarCrossref
43.
American Academy of Family Physicians. Atrial fibrillation: screening with electrocardiography. Accessed December 6, 2021. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/atril-fib.html
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close