Screen-detected atrial fibrillation prevalence and adherence to therapeutic recommendations in a fully digital nationwide patch-based ECG screening: the NORSCREEN randomised clinical trial
M Boskovic, M B Haraldsen, T Berge, B L Grenne, P T Skretteberg, J Engdahl, M L Lochen, P Schuster, J Grimsmo, D Atar, O G Anfinsen, A H Pripp, J Jortveit, S HalvorsenAbstract
Background
Conventional screening modalities for atrial fibrillation (AF) are often constrained by considerable resource and logistical demands. The randomised controlled Norwegian AF Self-Screening trial (NORSCREEN) adopts a fully digital approach to participant recruitment and trial implementation.
Purpose
To evaluate the effectiveness of a fully digital recruitment and screening strategy in nationwide AF screening, determine the prevalence of screen-detected AF, and assess adherence to therapeutic recommendations for anticoagulation therapy.
Methods
Individuals aged ≥65 years with at least one additional risk factor for stroke were digitally recruited from the general Norwegian population and randomized 1:1 to screening or usual care. Exclusion criteria were prior AF, current anticoagulation therapy, implantable cardiac electronic devices, or lack of smartphone access. Participants allocated to screening received a patch-based electrocardiogram sensor by mail for site-less continuous monitoring over seven days. Individuals with screen-detected AF were advised to contact their general practitioner to initiate guideline-directed therapy.
Results
A total of 551,555 residents were digitally invited. Of these, 139,596 (25.3%) completed the digital eligibility assessment, 74,956 (53.7%) were eligible, and 50,549 (67.4%) consented to participate (Figure 1). The median age was 75 years [IQR: 69-78], 23,445 (46.4%) were female, and the mean CHA2DS2-VA risk score was 2.6 ±0.9. In the screening group, 19,723 (78.1%) completed the study procedures. Previously undiagnosed AF was identified in 382 (1.9%) screened participants (Figure 2). The proportion of participants with screen-detected AF increased with age and was significantly higher in men than in women (2.6% vs 1.2%, p≤0.001). 95.8% of the participants with screen-detected AF reported initiating anticoagulation therapy.
Conclusions
The NORSCREEN trial demonstrates that fully digital, large-scale, site-less AF screening is feasible and effective in an at-risk population, identifying previously undiagnosed AF in 1.9% of screened individuals and showing high adherence to anticoagulation therapy recommendations.Figure 1Figure 2