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Mass screening for atrial fibrillation using n-terminal pro b-type natriuretic peptide - preliminary results from the strokestop 2 study

Session Atrial fibrillation - Detection, treatment, outcomes

Speaker Doctor Katrin Kemp Gudmundsdottir

Event : ESC Congress 2018

  • Topic : arrhythmias and device therapy
  • Sub-topic : Epidemiology, Prognosis, Outcome
  • Session type : Rapid Fire Abstracts

Authors : K Kemp Gudmundsdottir (Stockholm,SE), E Svennberg (Stockholm,SE), F Al-Khalili (Stockholm,SE), T Fredriksson (Stockholm,SE), V Frykman (Stockholm,SE), L Friberg (Stockholm,SE), M Rosenqvist (Stockholm,SE), J Engdahl (Stockholm,SE)

Authors:
K. Kemp Gudmundsdottir1 , E. Svennberg1 , F. Al-Khalili1 , T. Fredriksson1 , V. Frykman1 , L. Friberg2 , M. Rosenqvist1 , J. Engdahl1 , 1Danderyd University Hospital - Stockholm - Sweden , 2Karolinska Institute - Stockholm - Sweden ,

Topic(s):
Atrial Fibrillation - Epidemiology, Prognosis, Outcome

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 264

Background: Atrial fibrillation (AF) is common among the elderly and a significant risk-factor for embolic ischemic stroke. AF is often asymptomatic and therefore undiagnosed. We have previously reported a yield of 3% of newly diagnosed AF using intermittent ECG screening in a 75-year-old population. N-terminal pro b-type natriuretic peptide (NT-proBNP) levels are elevated in patients with AF, and prior studies indicate that NT-proBNP elevation can predict development of AF. In patients with known AF, NT-proBNP levels seem to be in proportion to stroke risk.

Purpose: We aim at reporting preliminary data on the yield of systematic screening for AF in a 75/76-year-old population using NT-proBNP and handheld ECG recordings in a stepwise screening procedure.

Methods: All individuals born in 1940 and 1941 residing in the Stockholm region (n=28,712) were randomised in a 1:1 fashion to be invited to a screening program for AF or to serve as a control group. Participants free of AF (n=6127) had NT-proBNP analysed. Individuals with NT-proBNP ≥125 ng/L (n=3636, 59%) were offered extended ECG-screening whereas individuals with NT-proBNP <125 ng/L (n=2491, 41%) had a single one-lead ECG recording.

Results: In participants with NT-proBNP ≥125 ng/L 169 (4,6%, 95% CI 4.0–5.4) were diagnosed with AF, of these 32 (24%) were diagnosed on their first ECG recording. One participant with NT-proBNP <125ng/L was diagnosed with AF on a single-lead ECG. Oral anticoagulation (OAC) treatment was initiated in 93% of those with new AF. In the population randomized to screening OAC treatment was commenced in 1% (158/13845).

Conclusions: NT-proBNP-enriched systematic screening for AF identified a significant proportion of participants with untreated AF. Oral anticoagulation treatment was highly accepted in the group diagnosed with AF.

AF detection

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