Detection rates of asymptomatic carotid artery stenosis and atrial fibrillation by selective screening of patients without cardiovascular disease

Michiel H F Poorthuis; Paul Sherliker; Gert J de Borst; Rachel Clack; Sarah Lewington; Robert Clarke; Richard Bulbulia; Alison Halliday

doi:10.1016/j.ijcard.2023.131262

Detection rates of asymptomatic carotid artery stenosis and atrial fibrillation by selective screening of patients without cardiovascular disease

Int J Cardiol. 2023 Nov 15:391:131262. doi: 10.1016/j.ijcard.2023.131262. Epub 2023 Aug 11.

Authors

Michiel H F Poorthuis¹, Paul Sherliker², Gert J de Borst³, Rachel Clack², Sarah Lewington⁴, Robert Clarke², Richard Bulbulia⁵, Alison Halliday⁴

Affiliations

¹ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands.
² Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
³ Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands.
⁴ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁵ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. Electronic address: richard.bulbulia@ndph.ox.ac.uk.

PMID: 37574023
DOI: 10.1016/j.ijcard.2023.131262

Abstract

Background: Individuals with significant asymptomatic carotid artery stenosis (ACAS) and atrial fibrillation (AF) could benefit from specific interventions to prevent heart attack and stroke, but are often clinically 'silent'. We aimed to determine detection rate of ACAS and AF by screening, targeting a population at increased cardiovascular risk.

Methods: Data on adults who attended voluntary and self-funded commercial screening clinics in the United States or the United Kingdom between 2008 and 2013 were used. The Atherosclerotic Cardiovascular Disease (ASCVD) risk equation was applied to each participants and detection rates of targeted screening for ≥50% ACAS and AF to those at highest risk of CVD was assessed.

Results: Among 0.4 million individuals between 40 and 80 years, without CVD, 6191 (1.6%) had ACAS and 1026 (0.3%) had AF. Selective screening of participants with a predicted 10-year CVD risk of ≥20% identified 40% of ACAS cases, a prevalence of 3.7%, leading to a number needed to screen (NNS) of 27, as well as 39% of AF cases, a prevalence of 0.6%, with a NNS of 170. Selective screening of those with a predicted 10-year CVD risk of ≥15% identified 54% of ACAS cases, a prevalence of 3.3%, and an NNS of 31, as well as 51% of AF cases, a prevalence of 0.5%, with an NNS of 195.

Conclusions: Selective screening for ACAS and AF implemented in ASCVD risk assessment greatly reduces the NNS when compared with population-level screening with detection rates of ACAS and AF substantially greater in people at higher predicted CVD risk.

Keywords: Atrial fibrillation; Ischaemic stroke; Primary prevention; Risk prediction; Selective screening; carotid artery stenosis.

MeSH terms

Adult
Atherosclerosis*
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Cardiovascular Diseases* / diagnosis
Cardiovascular Diseases* / epidemiology
Carotid Stenosis* / diagnostic imaging
Carotid Stenosis* / epidemiology
Humans
Mass Screening
Risk Assessment
Risk Factors
Stroke* / diagnosis
Stroke* / epidemiology
Stroke* / etiology