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

• Published in: International journal of cardiology Vol. 391; p. 131262
• Main Authors: Poorthuis, Michiel H.F., Sherliker, Paul, de Borst, Gert J., Clack, Rachel, Lewington, Sarah, Clarke, Robert, Bulbulia, Richard, Halliday, Alison
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 15.11.2023
• Subjects: Atrial fibrillation; carotid artery stenosis; Ischaemic stroke; Primary prevention; Risk prediction; Selective screening; Risk prediction; carotid artery stenosis; Selective screening; Primary prevention; Atrial fibrillation; Ischaemic stroke
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2023.131262

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. 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. 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. 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. •Early detection of ACAS and AF could allow effective primary prevention.•Population-level screening results in a high number needed to screen, and is not recommended.•Selective screening, based on ASCVD scores halves the NNS, allowing targeted screening.