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 electrocardiogram (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 (NtproBNP), on risk factors, disease symptoms, and echocardiographic variables.

Results-Of 15,010 individuals, 466 (3.1%) had AF. New AF was found in N=32, 0.2% of the total sample, 0.5% of individuals aged 65 to 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 ten years. In the 65-74 year age group, the cost per qualityadjusted life-year gained resulting from a single timepoint screening was 30,361EUR. In simulations, the costs were highly sensitive to AF detection rates, proportion of treatment and type of oral anticoagulant. Pre-screening 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. Costeffectiveness 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.