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Screening strategies for atrial fibrillation in the elderly population : a systematic review and network meta-analysis
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O rastreio oportunístico para fibrilhação atrial é atualmente recomendado para doentes com 65 anos ou mais. Contudo, isto foi recentemente posto em causa por dois estudos que relatam que o rastreio oportunístico não é mais eficaz do que os cuidados habituais. Além disso, não parece haver consenso sobre qual é a estratégia de rastreio mais eficaz (oportunística ou sistemática). Assim, procurámos comparar as diferentes estratégias utilizando a metodologia da revisão sistemática com meta-análise em rede.
Foi realizada uma pesquisa eletrónica na base de dados do MEDLINE, CENTRAL e EMBASE. Além disso, pesquisámos OpenGrey, conhecimentos de peritos e analisámos a lista de referência dos estudos incluídos ou outras publicações relevantes. A pesquisa foi realizada a 2 de Novembro de 2020 e atualizada a 20 de Setembro de 2021. Realizámos uma meta-análise de efeitos aleatórios e uma meta-análise em rede de efeitos aleatórios dentro de uma estrutura frequentista, numa análise de intenção de rastreio. Reportámos os resultados como risco relativo (RR) com intervalos de confiança de 95% (IC). Avaliámos a confiança na evidência utilizando a estrutura GRADE.
Foram incluídos 9 estudos, com um total de 80665 participantes. Os resultados indicam que o rastreio sistemático é eficaz quando comparado com os cuidados habituais (RR 2.11; 95% CI 1.48 a 3.02; confiança GRADE elevada) e quando comparado com o rastreio oportunístico (RR 1.86; CI 1.23 a 2.82; confiança GRADE elevada) mas não foi encontrada qualquer diferença significativa entre o rastreio oportunístico e os cuidados habituais (RR 1.13; 95% CI 0.79 a 1.63; confiança GRADE baixa).
O rastreio sistemático foi a estratégia mais eficaz para detetar a fibrilhação atrial em indivíduos com 65 anos ou mais. O rastreio oportunístico não foi mais eficaz do que os cuidados habituais, mas os resultados foram enfraquecidos por uma baixa qualidade de evidência devido ao risco de enviesamento dos estudos incluídos e imprecisão nos resultados. Número de registo PROSPERO: CRD42020218672
Opportunistic screening for atrial fibrillation is currently recommended for patients aged 65 years and older. However, this has recently been called into question by two studies that report that opportunistic screening is no more effective than usual care. Furthermore, there seems to be no consensus on which is the most effective screening strategy (opportunistic or systematic). Thus, we aimed to compare the different atrial fibrillation detection strategies with each other using the methodology of systematic review with network meta-analysis. An electronic database search of MEDLINE, CENTRAL, and EMBASE was performed. In addition, we also searched OpenGrey, experts’ knowledge and screened the reference list of included studies or other relevant publications. The search was performed on the 2nd of November of 2020 and updated on the 20th of September of 2021. We performed a random-effects pairwise meta-analysis and a random-effects network meta-analysis within a frequentist framework in an intention to screen analysis. We reported the results as relative risk (RR) with 95% confidence intervals (CI). We assessed the confidence in the evidence using the GRADE framework. Nine studies were included, enrolling 80665 participants. Pooled effect sizes suggested that systematic screening was effective when compared with usual care (RR 2.11; 95% CI 1.48 to 3.02; high GRADE confidence) and when compared with opportunistic screening (RR 1.86; CI 1.23 to 2.82; high GRADE confidence) but no significant difference was found between opportunistic screening and usual care (RR 1.13; 95% CI 0.79 to 1.63; low GRADE confidence). Systematic screening was the most effective strategy for detecting atrial fibrillation in individuals aged 65 years or older. Opportunistic screening was no more effective than usual care, but the results were weakened by a low quality of evidence due to risk of bias of the included studies and imprecision in the results. PROSPERO registration number: CRD42020218672
Opportunistic screening for atrial fibrillation is currently recommended for patients aged 65 years and older. However, this has recently been called into question by two studies that report that opportunistic screening is no more effective than usual care. Furthermore, there seems to be no consensus on which is the most effective screening strategy (opportunistic or systematic). Thus, we aimed to compare the different atrial fibrillation detection strategies with each other using the methodology of systematic review with network meta-analysis. An electronic database search of MEDLINE, CENTRAL, and EMBASE was performed. In addition, we also searched OpenGrey, experts’ knowledge and screened the reference list of included studies or other relevant publications. The search was performed on the 2nd of November of 2020 and updated on the 20th of September of 2021. We performed a random-effects pairwise meta-analysis and a random-effects network meta-analysis within a frequentist framework in an intention to screen analysis. We reported the results as relative risk (RR) with 95% confidence intervals (CI). We assessed the confidence in the evidence using the GRADE framework. Nine studies were included, enrolling 80665 participants. Pooled effect sizes suggested that systematic screening was effective when compared with usual care (RR 2.11; 95% CI 1.48 to 3.02; high GRADE confidence) and when compared with opportunistic screening (RR 1.86; CI 1.23 to 2.82; high GRADE confidence) but no significant difference was found between opportunistic screening and usual care (RR 1.13; 95% CI 0.79 to 1.63; low GRADE confidence). Systematic screening was the most effective strategy for detecting atrial fibrillation in individuals aged 65 years or older. Opportunistic screening was no more effective than usual care, but the results were weakened by a low quality of evidence due to risk of bias of the included studies and imprecision in the results. PROSPERO registration number: CRD42020218672
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Fibrilhação atrial Rastreio Meta análise em rede Cardiologia