Wearables, Smartphones and Novel Anticoagulants: We Will Treat More Atrial Fibrillation, but Will Patients Be Better Off?

Abstract

The widespread adoption of medical practices without a firm evidence base is common and the current growing enthusiasm for atrial fibrillation screening offers a real-time example of this phenomenon. Although no randomized trials supporting the utility of screening for atrial fibrillation exist, proponents suggest that such screening should be considered. Atrial fibrillation is a common condition that is often asymptomatic. It is also a condition associated with serious morbidity, primarily resulting from stroke. We practice at a time in which the ability to detect atrial fibrillation is becoming easier and treatments are becoming less onerous. Screening for atrial fibrillation may be beneficial but there is also a reasonable likelihood that its harms will outweigh it benefits. In this article we make the case that adopting this practice prior to data from randomized controlled trial would be a mistake. If screening for atrial fibrillation is adopted without such a robust evidence base we may well later discover that this course of action was wrong.

Keywords: anticoagulation; atrial fibrillation; medical decision making; medical reversal.