Screening for atrial fibrillation: the role of CHA2DS2-VASc and atrial fibrillation burden

Individuals with subclinical atrial fibrillation (AF) face an increased risk of thromboembolic events, which may potentially be mitigated through AF screening and subsequent anticoagulation. However, data from randomized clinical trials (RCTs) indicate a lower stroke risk in subclinical AF compared with the clinical phenotype. This-along with the inherent bleeding risk related to anticoagulation-seems to render the net clinical benefit of AF screening less evident. Further, current guidelines recommend consideration of CHA2DS2-VASc score and AF episode duration to guide screening and treatment. These recommendations, in general, lack support and seem questionable in view of the limited RCT data. More evidence is warranted to provide insights into the potential benefits of screening and treatment of screen-detected AF in specific population subgroups and AF phenotypes.