目的 评估在城市医疗集团模式下，于医院就诊人群中实施基于单导联心房颤动（房颤）检测棒的机会性房颤筛查的长期成本效益。方法 基于经广州市本地流行病学数据校准的Markov模型，比较未筛查与基于单导联房颤检测棒的不同筛查频率（季度、半年、年度）的机会性筛查策略，从卫生服务提供方视角评估成本与质量调整生命年（QALY），计算增量净货币收益（INMB）与成本效果比（ICER），并进行概率及情景敏感性分析。结果 所构建的房颤模型具有良好的预测效度。在基线假设下，季度筛查策略表现最优，相较未筛查组可增加0.525 5个QALY，节省成本15?626.61元，INMB为85 312.14元。敏感性分析显示，抗凝治疗依从性对成本效益影响最大。情景分析中，不同灵敏度与特异度假设未改变最优策略结论。结论 在城市医疗集团情境下，针对65岁及以上就诊老年人群的基于单导联房颤检测棒的季度机会性房颤筛查具备稳健的成本效益。结合分级诊疗体系和全流程管理，以依从性管理作为干预重点，能够最大化卒中预防收益并提高资源配置效率。

      Objective To evaluate the long-term cost-effectiveness of opportunistic atrial fibrillation（AF）screening using a single-lead handheld ECG device among hospital-attending adults within an urban medical consortium．Methods No screening and opportunistic screening at different frequencies（quarterly，semiannual，and annual）were compared by a Markov model calibrated to Guangzhou-specific epidemiological data．From the healthcare provider perspective，we estimated costs and quality-adjusted life-years（QALYs），calculated incremental net monetary benefit（INMB）and incremental cost-effectiveness ratio（ICER），and performed probabilistic and scenario sensitivity analyses．Results The AF model demonstrated good predictive validity．Under the baseline scenario，quarterly screening was the optimal strategy，yielding a gain of 0.525 5 QALYs，cost savings of CNY 15 626.61，and an INMB of CNY 85 312.14 versus no screening．Sensitivity analyses indicated that adherence to anticoagulation had the greatest impact on cost-effectiveness．Scenario analyses varying diagnostic sensitivity and specificity did not change the conclusion regarding the optimal strategy．Conclusions In the context of an urban medical consortium，quarterly opportunistic AF screening based on a single-lead handheld ECG device for hospital-attending adults aged ≥65 years is robustly cost-effective．Integrating screening into tiered care with end-to-end management，while prioritizing adherence management，can maximize stroke-prevention benefits and improve resource allocation efficiency．