Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model

Background Atrial fibrillation (AF) screening is endorsed by certain guidelines for individuals aged ≥65 years. Yet many AF screening strategies exist, including the use of wrist‐worn wearable devices, and their comparative effectiveness is not well‐understood. Methods and Results We developed a dec...

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Autores principales:	Shaan Khurshid, Wanyi Chen, Daniel E. Singer, Steven J. Atlas, Jeffrey M. Ashburner, Jin G. Choi, Chin Hur, Patrick T. Ellinor, David D. McManus, Jagpreet Chhatwal, Steven A. Lubitz
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	atrial fibrillation cost‐effectiveness microsimulation screening Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/b419df05eac54a90b0c96c943eccb6df
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spelling	oai:doaj.org-article:b419df05eac54a90b0c96c943eccb6df2021-11-23T11:36:35ZComparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model10.1161/JAHA.120.0203302047-9980https://doaj.org/article/b419df05eac54a90b0c96c943eccb6df2021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.120.020330https://doaj.org/toc/2047-9980Background Atrial fibrillation (AF) screening is endorsed by certain guidelines for individuals aged ≥65 years. Yet many AF screening strategies exist, including the use of wrist‐worn wearable devices, and their comparative effectiveness is not well‐understood. Methods and Results We developed a decision‐analytic model simulating 50 million individuals with an age, sex, and comorbidity profile matching the United States population aged ≥65 years (ie, with a guideline‐based AF screening indication). We modeled no screening, in addition to 45 distinct AF screening strategies (comprising different modalities and screening intervals), each initiated at a clinical encounter. The primary effectiveness measure was quality‐adjusted life‐years, with incident stroke and major bleeding as secondary measures. We defined continuous or nearly continuous modalities as those capable of monitoring beyond a single time‐point (eg, patch monitor), and discrete modalities as those capable of only instantaneous AF detection (eg, 12‐lead ECG). In total, 10 AF screening strategies were effective compared with no screening (300–1500 quality‐adjusted life‐years gained/100 000 individuals screened). Nine (90%) effective strategies involved use of a continuous or nearly continuous modality such as patch monitor or wrist‐worn wearable device, whereas 1 (10%) relied on discrete modalities alone. Effective strategies reduced stroke incidence (number needed to screen to prevent a stroke: 3087–4445) but increased major bleeding (number needed to screen to cause a major bleed: 1815–4049) and intracranial hemorrhage (number needed to screen to cause intracranial hemorrhage: 7693–16 950). The test specificity was a highly influential model parameter on screening effectiveness. Conclusions When modeled from a clinician‐directed perspective, the comparative effectiveness of population‐based AF screening varies substantially upon the specific strategy used. Future screening interventions and guidelines should consider the relative effectiveness of specific AF screening strategies.Shaan KhurshidWanyi ChenDaniel E. SingerSteven J. AtlasJeffrey M. AshburnerJin G. ChoiChin HurPatrick T. EllinorDavid D. McManusJagpreet ChhatwalSteven A. LubitzWileyarticleatrial fibrillationcost‐effectivenessmicrosimulationscreeningDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation cost‐effectiveness microsimulation screening Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atrial fibrillation cost‐effectiveness microsimulation screening Diseases of the circulatory (Cardiovascular) system RC666-701 Shaan Khurshid Wanyi Chen Daniel E. Singer Steven J. Atlas Jeffrey M. Ashburner Jin G. Choi Chin Hur Patrick T. Ellinor David D. McManus Jagpreet Chhatwal Steven A. Lubitz Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model
description	Background Atrial fibrillation (AF) screening is endorsed by certain guidelines for individuals aged ≥65 years. Yet many AF screening strategies exist, including the use of wrist‐worn wearable devices, and their comparative effectiveness is not well‐understood. Methods and Results We developed a decision‐analytic model simulating 50 million individuals with an age, sex, and comorbidity profile matching the United States population aged ≥65 years (ie, with a guideline‐based AF screening indication). We modeled no screening, in addition to 45 distinct AF screening strategies (comprising different modalities and screening intervals), each initiated at a clinical encounter. The primary effectiveness measure was quality‐adjusted life‐years, with incident stroke and major bleeding as secondary measures. We defined continuous or nearly continuous modalities as those capable of monitoring beyond a single time‐point (eg, patch monitor), and discrete modalities as those capable of only instantaneous AF detection (eg, 12‐lead ECG). In total, 10 AF screening strategies were effective compared with no screening (300–1500 quality‐adjusted life‐years gained/100 000 individuals screened). Nine (90%) effective strategies involved use of a continuous or nearly continuous modality such as patch monitor or wrist‐worn wearable device, whereas 1 (10%) relied on discrete modalities alone. Effective strategies reduced stroke incidence (number needed to screen to prevent a stroke: 3087–4445) but increased major bleeding (number needed to screen to cause a major bleed: 1815–4049) and intracranial hemorrhage (number needed to screen to cause intracranial hemorrhage: 7693–16 950). The test specificity was a highly influential model parameter on screening effectiveness. Conclusions When modeled from a clinician‐directed perspective, the comparative effectiveness of population‐based AF screening varies substantially upon the specific strategy used. Future screening interventions and guidelines should consider the relative effectiveness of specific AF screening strategies.
format	article
author	Shaan Khurshid Wanyi Chen Daniel E. Singer Steven J. Atlas Jeffrey M. Ashburner Jin G. Choi Chin Hur Patrick T. Ellinor David D. McManus Jagpreet Chhatwal Steven A. Lubitz
author_facet	Shaan Khurshid Wanyi Chen Daniel E. Singer Steven J. Atlas Jeffrey M. Ashburner Jin G. Choi Chin Hur Patrick T. Ellinor David D. McManus Jagpreet Chhatwal Steven A. Lubitz
author_sort	Shaan Khurshid
title	Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model
title_short	Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model
title_full	Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model
title_fullStr	Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model
title_full_unstemmed	Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model
title_sort	comparative clinical effectiveness of population‐based atrial fibrillation screening using contemporary modalities: a decision‐analytic model
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/b419df05eac54a90b0c96c943eccb6df
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Comparative Clinical Effectiveness of Population‐Based Atrial Fibrillation Screening Using Contemporary Modalities: A Decision‐Analytic Model

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