Several editorials discuss these data. The first calls for a widespread, cost-effective approach to AF screening not only in the US but around the world. It notes that given the aging of the world population and the growing prevalence of comorbidities that contribute to AF, including obesity and physical inactivity, the predicted epidemic of AF is already here. It warns that the costs of unrecognised—and thereby untreated—AF are too great from a personal and societal perspective to make this anything short of a major public health issue, though how best to address this issue remains to be seen.
The second editorial notes that currently, the identification of AF by screening may be the best available method to diagnose an underlying atrial myopathy that predisposes to AF-associated cardioembolic stroke but it is likely neither sensitive nor specific enough as an isolated approach. Improved algorithms that address the important interactions among risk scores, extent of atrial myopathy, and atrial fibrillation burden are required to optimise treatment.
The final editorial suggests that if AF screening is adopted in the absence of any outcomes data, hundreds of thousands, perhaps millions, of people will rightly and wrongly gain the diagnosis of a cardiac disorder. It stresses that before turning this many people into patients, there should be compelling evidence that the benefits of this label exceed the harms, and that these benefits can be achieved at an acceptable cost. It calls for RCTs of AF screening before adopting this practice.