{"id":7165,"date":"2025-04-29T10:00:59","date_gmt":"2025-04-29T08:00:59","guid":{"rendered":"https:\/\/family-medicine.org\/vorhofflimmer-screening\/"},"modified":"2025-04-29T19:57:06","modified_gmt":"2025-04-29T17:57:06","slug":"vorhofflimmer-screening","status":"publish","type":"post","link":"https:\/\/family-medicine.org\/de\/vorhofflimmer-screening\/","title":{"rendered":"Sollten wir Vorhofflimmer-Screenings durchf\u00fchren? Die ESC sagt Ja (2024), die Evidenz sagt&#8230;?"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"7165\" class=\"elementor elementor-7165 elementor-7135\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2d20363 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2d20363\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-295a041\" data-id=\"295a041\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fba1816 elementor-widget elementor-widget-text-editor\" data-id=\"fba1816\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Im November 2024 wurden zwei neue randomisierte Studien publiziert, die untersuchten, ob Vorhofflimmer-Screening mit einem EKG wirksam ist. Beide zeigten <strong>keinen<\/strong> relevanten Benefit. Dennoch wird es von den neuen ESC Leitlinien empfohlen. Warum? Hier mehr Infos dazu.<\/p><h3><strong>Neue Studie 1: <\/strong><a href=\"https:\/\/www.jacc.org\/doi\/10.1016\/j.jacc.2024.08.019\"><strong>GUARD-AF<\/strong><\/a><\/h3><ul><li><strong>Probanden:<\/strong> 12.000 Prim\u00e4rversorgungs-Patienten (Durchschnittsalter 75) in den USA<\/li><li><strong>Intervention:<\/strong> Screening mit einem Holter-EKG f\u00fcr 2 Wochen vs. normale Versorgung<\/li><li><strong>Ergebnis:<\/strong> in der Screening-Gruppe wurde VHFA zwar h\u00e4ufiger diagnostiziert und orale Antikoagulation h\u00e4ufiger eingeleitet, Schlaganf\u00e4lle wurden dadurch jedoch keine vermieden:<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-35764b2 elementor-widget elementor-widget-image\" data-id=\"35764b2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" data-attachment-id=\"7304\" data-permalink=\"https:\/\/family-medicine.org\/de\/bildschirmfoto-2025-04-29-um-19-53-16\/\" data-orig-file=\"https:\/\/family-medicine.org\/wp-content\/uploads\/2025\/04\/Bildschirmfoto-2025-04-29-um-19.53.16.png\" data-orig-size=\"945,476\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Bildschirmfoto-2025-04-29-um-19.53.16\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/family-medicine.org\/wp-content\/uploads\/2025\/04\/Bildschirmfoto-2025-04-29-um-19.53.16.png\" width=\"945\" height=\"476\" src=\"https:\/\/family-medicine.org\/wp-content\/uploads\/2025\/04\/Bildschirmfoto-2025-04-29-um-19.53.16.png\" class=\"attachment-large size-large wp-image-7304\" alt=\"\" srcset=\"https:\/\/family-medicine.org\/wp-content\/uploads\/2025\/04\/Bildschirmfoto-2025-04-29-um-19.53.16.png 945w, https:\/\/family-medicine.org\/wp-content\/uploads\/2025\/04\/Bildschirmfoto-2025-04-29-um-19.53.16-300x151.png 300w, https:\/\/family-medicine.org\/wp-content\/uploads\/2025\/04\/Bildschirmfoto-2025-04-29-um-19.53.16-768x387.png 768w\" sizes=\"(max-width: 945px) 100vw, 945px\" data-attachment-id=\"7304\" data-permalink=\"https:\/\/family-medicine.org\/de\/bildschirmfoto-2025-04-29-um-19-53-16\/\" data-orig-file=\"https:\/\/family-medicine.org\/wp-content\/uploads\/2025\/04\/Bildschirmfoto-2025-04-29-um-19.53.16.png\" data-orig-size=\"945,476\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Bildschirmfoto-2025-04-29-um-19.53.16\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/family-medicine.org\/wp-content\/uploads\/2025\/04\/Bildschirmfoto-2025-04-29-um-19.53.16.png\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c5afc0e elementor-widget elementor-widget-text-editor\" data-id=\"c5afc0e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3><strong>Neue Studie 2: <\/strong><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.124.071176\"><strong>STROKESTOP-II<\/strong><\/a><\/h3><ul><li><strong>Probanden:<\/strong> alle (!) 75 und 76 J\u00e4hrigen Einwohner Stockholms wurden randomisiert (29.000 Personen)<\/li><li><strong>Intervention:<\/strong> NT-proBNP Abnahme + 1 EKG bei BNP unter 125 ng\/L (bei 40% der Personen) oder t\u00e4glich 4 EKG f\u00fcr 2 Wochen bei h\u00f6herem BNP (bei 60%) vs. normale Versorgung<\/li><li><strong>Ergebnis:<\/strong> nach 5 Jahren waren Schlaganf\u00e4lle und Thrombembolien trotz Screening gleich h\u00e4ufig (HR 0.96, 95% CI 0.86-1.06); limitierend war, dass nur 49% der Eingeladenen am Screening teilnehmen<\/li><\/ul><h3><strong>Was empfiehlt die neue <\/strong><a href=\"https:\/\/academic.oup.com\/eurheartj\/article\/45\/36\/3314\/7738779\"><strong>2024 ESC Guideline<\/strong><\/a><strong>?<\/strong><\/h3><ul><li><strong>Routinem\u00e4\u00dfige Herzrhythmus-Assessments <\/strong>bei allen Arztbesuchen von Patienten ab 65 Jahren (Class I, Level C)<\/li><li><strong>Holter-EKG <\/strong>bei allen Patienten ab 75 Jahren und bei allen ab 65 Jahren mit einem zus\u00e4tzlichen CHA2DS2-VA Risikofaktor (Class IIa, Level B)<\/li><\/ul><p>Das \u00fcberrascht, da selbst im Text derselben ESC Guideline steht, dass \u201ces an ausreichend gro\u00dfen RCTs zur Rate isch\u00e4mischer Schlaganf\u00e4lle bei Patienten nach Vorhofflimmer-Screening mangelt\u201c und dass \u201ees unklar ist &#8230; welche Patienten von einem Screening am meisten profitieren k\u00f6nnten\u201c.<\/p><h3><strong>Wie unabh\u00e4ngig ist diese ESC Guideline?<\/strong><\/h3><p>Die deutsche Initiative \u201e<a href=\"https:\/\/www.leitlinienwatch.de\/\"><strong>Leitlinienwatch.de<\/strong><\/a>\u201c bewertet medizinische Behandlungsleitlinien auf ihre Unabh\u00e4ngigkeit von der Pharmaindustrie. Bis zu 18 Punkte bekommt man f\u00fcr Ma\u00dfnahmen, die den Einfluss von Interessenkonflikten reduzieren. Die aktuelle ESC Guideline erhielt von Leitlinienwatch nur <a href=\"https:\/\/www.leitlinienwatch.de\/2024-esc-guidelines-for-the-management-of-atrial-fibrillation-developed-in-collaboration-with-the-european-association-for-cardio-thoracic-surgery-eacts\/\"><strong>3 von 18 Punkte<\/strong><\/a>. Abz\u00fcge gab es u.a. daf\u00fcr, dass 90% der Leitlinienkommission durchschnittlich 4 Interessenkonflikte angab, die beiden leitenden Autoren gaben zusammengez\u00e4hlt 14 Interessenkonflikte an.<\/p><p>Auch wenn man inhaltlich anderer Meinung ist, ESC Leitlinien sind einflussreich&#8230; Die \u00e4ltere <a href=\"https:\/\/academic.oup.com\/eurheartj\/article\/42\/5\/373\/5899003\">2020 ESC Leitlinie<\/a> zum Vorhofflimmern wurde bisher \u00fcber 10.000 Mal zitiert und \u00fcber 2 Millionen Mal gelesen.<\/p><h3><strong>Was empfehlen andere Guidelines?<\/strong><\/h3><ul><li><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000001193\">ACC\/AHA\/ACCP\/HRS Guideline<\/a> (2023): \u201cEs ist noch <strong>nicht<\/strong> nachgewiesen, dass Patienten mit einem hohen Risiko, Vorhofflimmern zu entwickeln, basierend auf einem validierten Risikoscore, vom Screening profitieren w\u00fcrden.\u201c<\/li><li><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2788340\">USPSTF Update<\/a> (2022): \u201cDie USPSTF kommt zu dem Schluss, dass die derzeitige Evidenz <strong>nicht<\/strong> ausreicht, um das Nutzen-Schaden-Verh\u00e4ltnis eines Vorhofflimmer-Screenings zu bewerten.\u201c<\/li><li><a href=\"https:\/\/view-health-screening-recommendations.service.gov.uk\/atrial-fibrillation\/\">UK National Screening Committee<\/a> (2019): \u201cEin Screening wird derzeit f\u00fcr diese Erkrankung <strong>nicht<\/strong>\u201d<\/li><li>Zwar keine Leitlinie, aber dennoch relevant: Das <a href=\"https:\/\/www.arznei-telegramm.de\/html\/2024_10\/2410078_01.html\">Arznei-Telegramm<\/a> kam 2021, 2023 und 2024 jeweils zum Ergebnis, dass bei asymptomatischen Personen ein Vorhofflimmer-Screening <strong>nicht<\/strong> sinnvoll ist.<\/li><\/ul><h3><span style=\"text-decoration: underline;\"><strong>Conclusio:<\/strong><\/span><\/h3><ul><li>Die meisten Leitlinien empfehlen bei asymptomatischen, \u00e4lteren Patienten <strong>kein<\/strong> Vorhofflimmer-Screening.<\/li><li>Auch zwei neue Studien zeigen daf\u00fcr <strong>keinen<\/strong> relevanten Benefit.<\/li><li>Die neue 2024 ESC Guideline sieht das anders und <strong>empfiehlt<\/strong> Vorhofflimmer-Screenings bei sehr gro\u00dfen Patientengruppen.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Obwohl aktuelle Studien keinen Nutzen gezeigt haben und andere Gremien davon abraten, empfehlen die neuen ESC-Leitlinien 2024 ein umfassendes Screening auf Vorhofflimmern. Hier die Evidenz und andere Empfehlungen.<\/p>\n","protected":false},"author":93452803,"featured_media":7161,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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