Intended for healthcare professionals

Letters Screening for atrial fibrillation

Screening for atrial fibrillation: one size does not fit all

BMJ 2019; 364 doi: (Published 28 March 2019) Cite this as: BMJ 2019;364:l1396
  1. Robert J MacFadyen, professor of medicine/cardiologist
  1. Cardiology, Royal Hobart Hospital, Hobart, TAS 7000, Australia
  1. robert.macfadyen{at}

The association between atrial fibrillation and thromboembolism is not as simple as portrayed.1 Labelling epiphenomena of heart ageing as illness is risky when causality in a complex confounded statistical association (stroke with chronic atrial fibrillation) is linked to defining the point at which anticoagulation reduces or defers recurrent injury and death. Stroke in chronic atrial fibrillation is not always thromboembolic, and anticoagulation reduces but does not eliminate stroke. Anticoagulation also causes death due to bleeding in a minority of cases, which are not reliably …

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