Systematic NT-proBNP and ECG Screening for Atrial Fibrillation Among 75 Year Old Subjects in the Region of Stockholm, Sweden - STROKESTOP II

Study Overview
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Brief Summary
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STROKESTOP II will study if the biomarker NT-proBNP together with single-lead ECG can be used as a primary population screening tool for silent atrial fibrillation, and builds on previous results from the STROKESTOP study.

Official Title
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Systematic NT-proBNP and ECG Screening for Atrial Fibrillation Among 75 Year Old Subjects in the Region of Stockholm, Sweden - STROKESTOP II

Conditions
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Atrial Fibrillation, Stroke

Intervention / Treatment
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* Other: ECG screening (Zenicor-ECG) for atrial fibrillation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Individuals born 1940 and 1941 residing in Stockholm at the time of inclusion Exclusion Criteria: Not fulfilling the inclusion criteria

Ages Eligible for Study
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Minimum Age: 75 Years
Maximum Age: 76 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ECG screening<br>Will be screened for AF using only one-stop protocol | Other: ECG screening (Zenicor-ECG) for atrial fibrillation<br>* Determination of the biomarker NT-proBNP together with single-lead ECG screening for silent atrial fibrillation.<br>|
| Control group<br>as per regular standard as of today | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of stroke or systemic embolism in the control group vs the intervention group | Endpoints collected from the Swedish patient registry will be compared between the groups | Five years | 
| Incidence of stroke or systemic embolism in the control group vs the low-risk group (with NT-proBNP<125 ng/L and normal index 1-lead ECG). | Endpoints collected from the Swedish patient registry will be compared between the groups | Five years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of major bleeding, ischaemic stroke, systemic embolism and death in the control group vs the intervention group | Endpoints collected from the Swedish patient registry will be compared between the groups | Five years | 
| Number of subjects with new discovered AF using intermittent ECG-recordings in the high risk Group with NT-proBNP>125 ng/L. | All individuals with NT-proBNP>125ng/L will undergo intermittent ECG recordings at least twice daily for two weeks. | Two years | 
| To assess screening uptake with regards to socio-demographic factors and to study if we can improve uptake in the screening programme by decentralizing the recruitment procedure. | Participants and non-participants will be compared using socioeconomic data provided by statistics sweden | Two years | 
| Cost per gained quality-adjusted life-year (QALY) and cost per avoided stroke of the STROKESTOP II screening program. | With the same statistical methods used in STROKESTOP I, the number of fewer years with undetected AF will be calculated as well as the number of avoided strokes, the number of life-years and the number of quality-adjusted life years (QALYs) per 1000 screened patients. The result will be reported as the incremental cost per gained QALY and per avoided stroke. | Five years | 
| Plasma and serum biomarkers and their relation to incidence of new AF and short episodes of AF (micro-AF) | serum and plasma biomarkers within coagulation, inflammation, cardiomyocyte stress, atrial fibrosis, electrical remodelling, prothrombotic state and altered haemodynamics will be analysed with immunoassays, in order to identify the best discriminator for silent AF on population level. https://www.olink.com/products/cvd-iii-panel/ | Five years | 
| To assess the incidence of heart failure in patients with NT-proBNP>125ng/L | To assess the value of structured follow-up with echocardiography in participants without known heart failure, but with increased NT-proBNP as a method to diagnose heart failure with reduced and preserved ejection fraction; and to assess whether in patients with NT-proBNP > 125 pg/mL, a higher cut-off can be used to predict HF on echocardiography, and thus be used to triage asymptomatic patients to echocardiography. | Five years | 
| To study atrial function in patients with and without silent atrial fibrillation | In a subset of participants with and without atrial fibrillation, advanced atrial echocardiography will be performed | Five years | 
| To study the correlation between symptoms and newly discovered AF | Participants are asked if they have had symptoms of palpitations before screening visit | Four years | 
| To study the diagnostic performance of pulse-palpation in AF screening as compared to one-lead ECG | pulse palpation will be performed in all participants and then a single-lead ECG will be registered | Four years | 
| To study the association of very short episodes of AF (micro-AF, episodes lasting shorter than 30 seconds) and incident AF | Individuals with micro-AF, defined as at least five supraventricular ectopics in a row but lasting shorter than 30 seconds at any time during intermittent screening will be compared to participants without micro-AF with regard to incident AF during screening. | Two years | 
| To compare different ECG modalities for AF screening | A subset of participants will perform both single-lead, handheld, intermittent ECG (Zenicor) and continuous event loop ECG recordings (Novacor R-test 4) and AF yield (defined as at least one episode of AF with a duration of 30 seconds) will be compared between the methods. Tolerability to both methods will be measured qualitatively with a questionnaire. | Two years | 
| Incidence of undiagnosed hypertension in participants | Blood pressure will be measured and participants with elevated blood pressure but no previous diagnosis of hypertension will be referred for further evaluation | four years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Screening, Stroke prevention, Cost effectiveness