National Center for Health Research: April 22, 2020
We appreciate the opportunity to comment on the United States Preventive Services Task Force’s draft research plan regarding Atrial Fibrillation Screening With Electrocardiography. The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety.
We commend the assessment of the potential benefits and harms of electrocardiography screening among asymptomatic adults. Furthermore, we applaud the commitment to assessing these potential benefits and harms by subgroups defined by stroke risk, as well as by race/ethnicity, age, and sex. The acknowledgement that diverse populations may differentially benefit or be harmed by screening is key, and is often overlooked in guidelines for screening and treatment.
We also commend the evaluation of the accuracy of different screening tests. However, we suggest additionally assessing whether health outcomes and accuracy of screening also vary based on demographic subgroups that probably also vary by level of stroke risk. Evaluating outcomes for different subgroups (such as race/ethnicity x age x sex x stroke risk) may reveal differences that are not obvious if when only examining one demographic or stroke variable at a time.
Similarly, we commend the assessment of whether anticoagulant and antiplatelet therapies for those already diagnosed with atrial fibrillation have potential harms. It is important that these harms are also assessed by subgroups, researching the potential harms for each subgroup.
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