ESC 2024: Mass AF screening via ECG plus heart failure biomarker does not prevent stroke in older patients

Mass screening for atrial fibrillation (AF) utilizing electrocardiography (ECG) along with a coronary heart failure biomarker doesn’t forestall ischaemic stroke or systemic in older adults—aged 75–76 years—over 5 years of follow-up. Nonetheless, the biomarker in query could enhance the prediction of which people have a low threat for ischaemic stroke and systemic embolism past single-lead ECG in older adults present process mass screening for AF.

That’s in keeping with late-breaking analysis introduced on the latest European Society of Cardiology (ESC) congress (30 August–2 September, London, UK).

“Our findings don’t assist this fashion of systematic screening for AF in older adults, however they point out that it could be secure to not focus screening efforts at these people with low ranges of NT-proBNP [N-terminal pro-B-type natriuretic peptide]—though this wants affirmation in additional research,” mentioned Katrin Kemp Gudmundsdottir (Karolinska Institute, Stockholm, Sweden), lead writer for the STROKESTOP II examine. “People with a low biomarker stage ran a decrease threat of each creating AF in the course of the five-year follow-up in addition to stroke or systemic embolism in comparison with each the management group and people with greater biomarker ranges.”

Internationally, most AF tips at the moment advocate ‘opportunistic screening’ for AF in individuals aged 65 years and older, and oral anticoagulant therapy for these at excessive stroke threat. The ESC additionally recommends systematic ECG screening to detect AF in sufferers aged 75 years or older, or these at excessive stroke threat. Additionally it is believed that including biomarkers may improve screening accuracy, and analysis suggests NT-proBNP—a marker of cardiovascular well being—to be a powerful predictor of incident AF and stroke.

In 2020, the baseline screening outcomes of the STROKESTOP II trial confirmed that NTproBNP might be helpful as a stratifying instrument for screening of AF, and that these with elevated NTproBNP may profit from extra intensive screening.

STROKESTOP II—a mass screening programme of all 75–76-year-olds within the Stockholm area of Sweden—enrolled 28,712 individuals born between 1940 and 1941 to look at whether or not being invited for screening would cut back the chance of thromboembolic occasions in comparison with a management group of sufferers not invited for screening. Analyses of these invited for screening included adults who got here for screening in addition to those that didn’t attend.

Individuals had been randomised in a 1:1 ratio to both be invited for AF screening (13,905 sufferers) or to the management group (13,884)—after excluding those that died or emigrated. Of these invited to screening, 6,843 (49%) accepted the invitation. Some 53% of those sufferers had been discovered to be girls.

Individuals with out beforehand identified AF had blood samples taken and NT­proBNP ranges analysed, and had been then stratified into high-risk (≥125 ng/L NT­proBNP) and low-risk (<125ng/L) teams. They had been then screened, based mostly on NT-proBNP stage, to both one-time (low-risk group) or extra intense (high-risk group) screening. Within the high-risk group (3,743 sufferers; 60%), screening was accomplished at house with a handheld, single-lead ECG gadget 4 occasions per day for 2 weeks, whereas, in low-risk members (2,545 sufferers; 40%), a single episode of screening was carried out with a single­-lead ­ECG however with out the 2 weeks of intensive screening.

Finally, new AF was detected in 2.4% (165 out of 6,843) of all members, who had been supplied oral anticoagulant therapy—as per consequence knowledge collected from nationwide Swedish registries. As well as, after a median follow-up of 5 years, no distinction was famous within the threat of any stroke or clotting occasion between the intervention group (together with invited members that each did and didn’t attend screening) and the management group.

Additional subanalyses discovered that the chance of stroke or blood clots was 41% decrease amongst members with low ranges of the center failure marker NT­proBNP in comparison with the management group (0.61 vs 1.03 occasions per 100 years in danger). Within the high-risk group consisting of these with elevated ranges of NT­proBNP, people had greater than double the chance of creating new AF within the 5 years, and the chance of ischaemic stroke or systemic embolism was 57% greater than within the low-risk group (0.95 vs 0.61 occasions per 100 years).

“Participation within the screening examine was decrease than anticipated and this might have hampered the outcomes,” Kemp Gudmundsdottir concluded. “Additional research are wanted, and it appears affordable to pay attention screening efforts on these at highest threat and probably decrease the incident of preventable strokes.”