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Original research
Incremental yield of ECG screening repeated annually over 4 years in an adult Japanese population without prior atrial fibrillation: a retrospective cohort study
  1. Yoshiki Nagata1,
  2. Takashi Yamagami1,
  3. Don Nutbeam2,
  4. Ben Freedman3,4,
  5. Nicole Lowres3,4
  1. 1Laboratory of Preventive Medicine, Hokuriku Health Service Association, Toyama, Japan
  2. 2School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  3. 3Heart Research Institute, Sydney, New South Wales, Australia
  4. 4Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Yoshiki Nagata; drnagata{at}


Objectives International guidelines recommend opportunistic screening for atrial fibrillation (AF); however, there is no current data to inform how often to repeat screening. We aimed to investigate the incremental annual yield and stroke risk of new AF cases in individuals screened annually over 4 years.

Design A retrospective cohort study.

Setting Hokuriku Health Service Association, Toyama prefecture, Japan.

Participants Employees and their families receiving annual health examinations from Hokuriku Health Service Association.

Intervention Each subject received an annual health examination (including 12-lead ECG) from 2014 to 2017. Only subjects with baseline ECGs in 2012 and/or 2013 were included.

Main outcome measures Rates (cases/100 person-years) of new AF identified each year for 4 consecutive years of screening (stratified according to gender and age groups). Calculated stroke risk of new AF cases using modified CHA2DS2-VASc scores (without heart failure data) (CHA2DS2VASc = C: congestive heart failure [1 point]; H: hypertension [1 point]; A2: age 65-74 years [1 point] or age ≥75 years [2 points]; D: diabetes mellitus [1 point]; S: prior stroke or transient ischemic attack [2 points]; VA: vascular disease [1 point]; and Sc: sex category [female] [1 point])

Results In 2014, 88 218 subjects had an ECG (46.8±12.5 years; 64% men): identifying 346 (0.39%) known AF and 69 (0.08%) new AF. The incidence rate of new AF increased with age from 0.01% (<50 years) to 0.98% (≥75 years) and was higher in men (0.1%) than women (0.05%). Repeated annual screening over 4 years identified a consistent new AF yield 0.06%–0.10% per year (0.33%–0.55% ≥65 years). Forty-two per cent of all new AF cases, and 76% of cases aged ≥65 years, had a class-1 oral anticoagulation (OAC) recommendation (modified CHA2DS2-VASc score ≥2 men, ≥3 women).

Conclusions Repeated annual ECG screening of the same population provides a consistent yield of new AF each year. The majority of new AF (≥65 years) are eligible for anticoagulation for stroke prevention. Although AF prevalence and incidence are lower in Japan than Western countries, 2318 new cases would be identified in Toyama prefecture each year with annual screening, of whom ~927 would have a high stroke risk with a recommendation for OAC therapy.

  • cardiac epidemiology
  • thromboembolism
  • pacing & electrophysiology

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  • Contributors YN, TY, DN, SBF and NL designed the study. YN and TY gained ethical approval and data collection. All authors contributed to data analysis. YN drafted the manuscript. All authors reviewed and approved the final manuscript.

  • Funding NL is funded by a NSW Health Early Career Fellowship (H16/52 168).

  • Competing interests SBF reports grants, personal fees and non-financial support from Bayer, grants, personal fees and non-financial support from BMS-PFizer, personal fees and non-financial support from Daiichi-Sankyo, outside the submitted work.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval has been granted through the Hokuriku Health Service Association Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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