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 might enhance the prediction of which people have a low danger for ischaemic stroke and systemic embolism past single-lead ECG in older adults present process mass screening for AF.

That’s in response to 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 research. “People with a low biomarker stage ran a decrease danger of each creating AF through the five-year follow-up in addition to stroke or systemic embolism in comparison with each the management group and people with larger biomarker ranges.”

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

In 2020, the baseline screening outcomes of the STROKESTOP II trial confirmed that NTproBNP may be helpful as a stratifying device for screening of AF, and that these with elevated NTproBNP would possibly 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 folks 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.

Contributors have 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 have been discovered to be girls.

Contributors with out beforehand identified AF had blood samples taken and NT­proBNP ranges analysed, and have been then stratified into high-risk (≥125 ng/L NT­proBNP) and low-risk (<125ng/L) teams. They have been then screened, primarily based 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 finished at residence with a handheld, single-lead ECG gadget 4 instances per day for 2 weeks, whereas, in low-risk contributors (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.

In the end, new AF was detected in 2.4% (165 out of 6,843) of all contributors, who have been provided oral anticoagulant therapy—as per end result knowledge collected from nationwide Swedish registries. As well as, after a median follow-up of 5 years, no distinction was famous within the danger of any stroke or clotting occasion between the intervention group (together with invited contributors 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 contributors with low ranges of the guts 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% larger than within the low-risk group (0.95 vs 0.61 occasions per 100 years).

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