Refined atrial fibrillation screening and cost-effectiveness in the German population
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Refined atrial fibrillation screening and cost-effectiveness in the German population. / Schnabel, Renate B; Wallenhorst, Christopher; Engler, Daniel; Blankenberg, Stefan; Pfeiffer, Norbert; Spruenker, Ngoc Anh; Buettner, Matthias; Michal, Matthias; Lackner, Karl J; Münzel, Thomas; Wild, Philipp S; Martinez, Carlos; Freedman, Ben; Gutenberg Health Study investigators.
In: HEART, Vol. 108, No. 6, 03.2022, p. 451-457.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Refined atrial fibrillation screening and cost-effectiveness in the German population
AU - Schnabel, Renate B
AU - Wallenhorst, Christopher
AU - Engler, Daniel
AU - Blankenberg, Stefan
AU - Pfeiffer, Norbert
AU - Spruenker, Ngoc Anh
AU - Buettner, Matthias
AU - Michal, Matthias
AU - Lackner, Karl J
AU - Münzel, Thomas
AU - Wild, Philipp S
AU - Martinez, Carlos
AU - Freedman, Ben
AU - Gutenberg Health Study investigators
N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/3
Y1 - 2022/3
N2 - OBJECTIVE: Little is known on optimal screening population for detecting new atrial fibrillation (AF) in the community. We describe characteristics and estimate cost-effectiveness for a single timepoint electrocardiographic screening.METHODS: We performed a 12-lead ECG in the German population-based Gutenberg Health Study between 2007 and 2012 (n=15 010), mean age 55±11 years, 51% men and collected more than 120 clinical and biomarker variables, including N-terminal pro B-type natriuretic peptide (Nt-proBNP), risk factors, disease symptoms and echocardiographic variables.RESULTS: Of 15 010 individuals, 466 (3.1%) had AF. New AF was found in 32 individuals, 0.2% of the total sample, 0.5% of individuals aged 65-74 years and predominantly men (86%). The classical risk factor burden was high in individuals with new AF. The median estimated stroke risk was 2.2%/year, while risk of developing heart failure was 21% over 10 years. In the 65-74 year age group, the cost per quality-adjusted life-year gained resulting from a single timepoint screening was €30 361. In simulations, the costs were highly sensitive to AF detection rates, proportion of treatment and type of oral anticoagulant. Prescreening by Nt-proBNP measurements was not cost-effective in the current setting.CONCLUSIONS: In our middle-aged population cohort, we identified 0.2% new AF by single timepoint screening. There was a significant estimated risk of stroke and heart failure in these individuals. Cost-effectiveness for screening may be reached in individuals aged 65 years and older. The simple age cut-off is not improved by using Nt-proBNP as a biomarker to guide a screening programme.
AB - OBJECTIVE: Little is known on optimal screening population for detecting new atrial fibrillation (AF) in the community. We describe characteristics and estimate cost-effectiveness for a single timepoint electrocardiographic screening.METHODS: We performed a 12-lead ECG in the German population-based Gutenberg Health Study between 2007 and 2012 (n=15 010), mean age 55±11 years, 51% men and collected more than 120 clinical and biomarker variables, including N-terminal pro B-type natriuretic peptide (Nt-proBNP), risk factors, disease symptoms and echocardiographic variables.RESULTS: Of 15 010 individuals, 466 (3.1%) had AF. New AF was found in 32 individuals, 0.2% of the total sample, 0.5% of individuals aged 65-74 years and predominantly men (86%). The classical risk factor burden was high in individuals with new AF. The median estimated stroke risk was 2.2%/year, while risk of developing heart failure was 21% over 10 years. In the 65-74 year age group, the cost per quality-adjusted life-year gained resulting from a single timepoint screening was €30 361. In simulations, the costs were highly sensitive to AF detection rates, proportion of treatment and type of oral anticoagulant. Prescreening by Nt-proBNP measurements was not cost-effective in the current setting.CONCLUSIONS: In our middle-aged population cohort, we identified 0.2% new AF by single timepoint screening. There was a significant estimated risk of stroke and heart failure in these individuals. Cost-effectiveness for screening may be reached in individuals aged 65 years and older. The simple age cut-off is not improved by using Nt-proBNP as a biomarker to guide a screening programme.
U2 - 10.1136/heartjnl-2020-318882
DO - 10.1136/heartjnl-2020-318882
M3 - SCORING: Journal article
C2 - 34376487
VL - 108
SP - 451
EP - 457
JO - HEART
JF - HEART
SN - 1355-6037
IS - 6
ER -
