Screening for Atrial Fibrillation in Asymptomatic Older Adults

This clinical decision feature presents opposing viewpoints on screening for atrial fibrillation (AF) in an asymptomatic 75-year-old man with hypertension and diabetes. Option 1 advocates for screening, citing the STROKESTOP trial’s modest reduction in stroke/systemic embolism (NNT=91) and guidelines recommending ECG screening in adults ≥65 years. Option 2 argues against screening, highlighting the LOOP trial’s null results (no significant stroke reduction with implantable loop recorders) and uncertainties about anticoagulation benefits for subclinical AF. The debate underscores the balance between potential stroke prevention and harms (e.g., bleeding, anxiety) amid pending trials (SAFER, NOAH, ARTESIA)

This clinical decision feature presents opposing viewpoints on screening for atrial fibrillation (AF) in an asymptomatic 75-year-old man with hypertension and diabetes. Option 1 advocates for screening, citing the STROKESTOP trial’s modest reduction in stroke/systemic embolism (NNT=91) and guidelines recommending ECG screening in adults ≥65 years. Option 2 argues against screening, highlighting the LOOP trial’s null results (no significant stroke reduction with implantable loop recorders) and uncertainties about anticoagulation benefits for subclinical AF. The debate underscores the balance between potential stroke prevention and harms (e.g., bleeding, anxiety) amid pending trials (SAFER, NOAH, ARTESIA)