Progression and clinical manifestations in screening-detected atrial fibrillation: A follow-up of the STROKESTOP study

Abstract

Background: There is a lack of data on atrial fibrillation (AF) progression after AF screening.

Hypothesis: We studied the hypothesis that progression of AF subtype after AF screening was similar to the progression noted in clinical AF cases. We also studied predictors for AF progression and AF symptoms during 5-year follow-up.

Methods: All participants from the STROKESTOP study with screening-detected AF were included in this prospective cohort study (n = 218). Deceased patients, patients with dementia and/or patients receiving institutional care were excluded (n = 31). Patients were interviewed at their visit regarding symptoms, treatment with oral anticoagulation and clinical events during follow-up and instructed to record ECG using a handheld ECG recording twice daily for two weeks.

Results: A total of 187 patients were invited for follow-up and 120 (64%) participated. The mean age was 81.0 ± 0.6 years and 56 (47%) of the participants were women. The mean follow-up time was 5.3 ± 0.4 years. Among the participants with 5-year follow-up data available, 18% (22/120) were diagnosed with permanent AF at study entry, compared to 49/120 (41%) after five years (p < 0.001). Among patients with paroxysmal AF at study entry, 33/98 (34%) had progressed to permanent AF after five years. Among participants approximately half remained asymptomatic, whereas 48% reported predominantly mild symptoms. None of the components of CHA₂DS₂-VASc were significantly predictive of AF progression.

Conclusions: The progression for screening-detected AF is like that of clinically detected AF. Half of the patients with screening-detected AF report symptoms over time, and symptoms were generally mild.